Showing papers in "Cadernos De Saude Publica in 2010"
TL;DR: A new food classification which assigns foodstuffs according to the extent and purpose of the industrial processing applied to them is described, and the impact of the replacement of group 1 foods and group 2 ingredients by group 3 products on the overall quality of the diet, eating patterns and health is discussed.
Abstract: This paper describes a new food classification which assigns foodstuffs according to the extent and purpose of the industrial processing applied to them. Three main groups are defined: unprocessed or minimally processed foods (group 1), processed culinary and food industry ingredients (group 2), and ultra-processed food products (group 3). The use of this classification is illustrated by applying it to data collected in the Brazilian Household Budget Survey which was conducted in 2002/2003 through a probabilistic sample of 48,470 Brazilian households. The average daily food availability was 1,792 kcal/person being 42.5% from group 1 (mostly rice and beans and meat and milk), 37.5% from group 2 (mostly vegetable oils, sugar, and flours), and 20% from group 3 (mostly breads, biscuits, sweets, soft drinks, and sausages). The share of group 3 foods increased with income, and represented almost one third of all calories in higher income households. The impact of the replacement of group 1 foods and group 2 ingredients by group 3 products on the overall quality of the diet, eating patterns and health is discussed.
595 citations
TL;DR: In this paper, the authors deal with the relations between masculinities and health care, approaching the recognition of health needs among male users of primary health care and the responses by the services.
Abstract: This study deals with the relations between masculinities and health care, approaching the recognition of health needs among male users of primary health care and the responses by the services. The study is part of a larger research project in four Brazilian States, with a convenience sample of eight health services. Ethnographic observation was compared with semi-structured interviews with 182 health care users from 15 to 65 years of age and 72 health professionals. Thematic analysis of the ethnographic records and interviews was based on gender references and studies on health work. The findings show how medicalization of health needs affects users, professionals, and services, disguising issues related to masculinity. Primary care focuses mainly on women, thereby reproducing gender inequalities in health services operations and professional performance, with women receiving disciplined care and men receiving insufficient attention and care.
150 citations
142 citations
TL;DR: Lack of integration among different providers, insufficient formal flows for hospital care, and absence of policies for medium complexity care were detected as barriers to the guarantee of comprehensive care, making the network's integration incomplete.
Abstract: This article analyzes the development of instruments for coordination between the Family Health Strategy and other levels in the health system, with a focus on measures to promote coordination linked to the "integration among levels of care". The results of case studies in four large cities indicate the presence of mechanism for integration among levels of care, suggesting concern with guaranteeing comprehensive care. The principal strategies identified here were: creation and strengthening of regulatory structures in the Municipal Health Secretariats and family health units with decentralization of roles to the local level, organization of flows, electronic patient charts, and expansion in the supply of specialized services at the municipal level. However, lack of integration among different providers, insufficient formal flows for hospital care, and absence of policies for medium complexity care were detected as barriers to the guarantee of comprehensive care, making the network's integration incomplete.
116 citations
TL;DR: Of the four health units analyzed, three showed intermediate-level implementation of measures targeting accessibility, and the Family Health Units showed better performance, due to measures for patient reception and referral to specialized services, but they revealed problems with scheduling of appointments.
Abstract: In order to analyze the implementation of measures targeting accessibility to primary health care in a municipality (county) in the State of Bahia, Brazil, a single case study was performed with two levels of analysis: system and services organization. The data were obtained from semi-structured interviews, observation of routine care, and document analysis. Of the four health units analyzed, three showed intermediate-level implementation of measures targeting accessibility. The Family Health Units showed better performance, due to measures for patient reception and referral to specialized services, but they revealed problems with scheduling of appointments. Despite having defined primary care as the portal of entry into the system and the implementation of a help desk for setting appointments with specialists, there are persistent organizational barriers in the municipality. A specific policy is recommended to improve accessibility, aimed at organization of the services supply in order to change the health care model.
102 citations
TL;DR: O objetivo foi descrever usuarios e nao-usuarios do Programa Academia da Cidade de Recife, Pernambuco, Brasil e o principal motivo para a participacao no programa foi "melhorar a saude".
Abstract: O objetivo foi descrever usuarios e nao-usuarios do Programa Academia da Cidade de Recife, Pernambuco, Brasil. Foram selecionados quatro dos 19 polos do programa. Para cada usuario sorteado, foi selecionado um nao-usuario, que foi pareado ao usuario em termos de sexo, idade (±5 anos) e local de residencia. A amostra foi composta por 277 usuarios e 277 nao-usuarios. Entre os nao-usuarios, 22% referiram nunca ter ouvido falar do programa. Entre os que ja ouviram falar do programa, 54,3% o conhecem por terem visto um polo. Entre os usuarios, o principal motivo para a participacao no programa foi "melhorar a saude"; o tempo medio de participacao no programa foi de 27,5 meses (DP = 23,1) e 72,8% relataram grau elevado de satisfacao. O percentual de pessoas com percepcao de saude regular ou ruim foi significativamente maior entre os nao-usuarios (45,4%) em comparacao aos usuarios (28,5%). Os usuarios do Programa Academia da Cidade parecem estar satisfeitos. Estrategias de divulgacao devem ser priorizadas para que o programa seja conhecido por um maior percentual de residentes de Recife.
88 citations
82 citations
TL;DR: There was a significant difference between diabetics and non-diabetics in terms of self-rated health, hospitalization, self-reported illness in the previous two weeks, and report of the following diseases.
Abstract: The aim of the study was to assess the prevalence of self-reported diabetes in the elderly, identifying associated factors, knowledge, and practices related to treatment options. This was a cross-sectional population-based study with stratified clustered two-stage sampling in six municipalities in the State of Sao Paulo, Brazil. Among the 1,949 elderly, 15.4% presented self-reported diabetes. Body mass index and exercising were statistically associated with diabetes. There was a significant difference between diabetics and non-diabetics in terms of self-rated health, hospitalization, self-reported illness in the previous two weeks, and report of the following diseases: hypertension, anemia, chronic kidney disease, and heart disease. In terms of per capita family income, there was no difference in regular medical visits, participation in discussion groups, and control practices. The findings show the need for behavior changes to prevent and control diabetes and its complications. Educational interventions are needed to expand the coverage of diabetes care.
80 citations
TL;DR: The FFQ showed fair relative validity for adolescents and adults, and may be used to study the dietary determinants of obesity and non-transmissible diseases in epidemiological surveys.
Abstract: This study assessed the validity of a food frequency questionnaire (FFQ-Porto Alegre), covering 135 food items, in comparison with the average of two consecutive 24-hour dietary recall questionnaires for adolescents, adults, and elderly who were randomly selected from a population-based survey. The Pearson correlation coefficients and cross-classification by quartiles of intake were used. The nutrients were log transformed and energy adjusted. The mean of adjusted de-attenuated correlation coefficient for adolescents was 0.44 and ranged from 0.18 (zinc) to 0.69 (folate) and for adult and elderly participants they were, respectively, 0.42, ranging from 0.16 (iron) to 0.73 (energy) and 0.52, ranging from 0.25 (vitamin E) to 0.84 (energy). The average classification percentage into the same or adjacent quartile for the two methods was 74.6% for adolescents, 74.9% for adults, and 81.2% for the elderly population. The FFQ showed fair relative validity for adolescents and adults, and may be used to study the dietary determinants of obesity and non-transmissible diseases in epidemiological surveys.
76 citations
TL;DR: The decrease in ill-defined causes of death indicates expanded access to health services and the increase in access to intrapartum and neonatal care contributed to the reduction in infant deaths, indicating the need for improvement in prenatal care.
Abstract: Infant deaths were classified as avoidable, non-avoidable, and resulting from ill-defined conditions, from 1997 to 2006, using the Brazilian List of Avoidable Causes of Mortality. Non-linear regression was used to calculate trends in cause-specific infant mortality rates. There was a significant decline in both avoidable deaths and deaths from ill-defined causes (p < 0.001). Avoidable deaths decreased by 37% overall. Mortality avoidable through adequate intrapartum care and adequate neonatal care decreased by 27.7% and 42.5%, respectively, while mortality avoidable through adequate prenatal care increased by 28.3%. In conclusion, health services contributed to the reduction in infant mortality. The decrease in ill-defined causes of death indicates expanded access to health services. The increase in access to intrapartum and neonatal care contributed to the reduction in infant deaths. The increase in mortality avoidable through adequate prenatal care indicates the need for improvement in prenatal care.
75 citations
TL;DR: This study focused on lawsuits to demand " essential" medicines, filed at the State Court of Appeals in Rio de Janeiro, Brazil, in 2006, and found that lawsuits demanding "essential" drugs were motivated not only by problems in procurement, distribution, and dispensing of medicines but also by non-inclusion of medicines on official lists.
Abstract: Recognition of the right to health raises two practical issues: the government's ethical and legal duty to ensure comprehensive health care and citizens' recourse to legal action to guarantee this right. This study focused on lawsuits to demand "essential" medicines, filed at the State Court of Appeals in Rio de Janeiro, Brazil, in 2006. One hundred and eighty-five suits were examined, and the claims were granted in all but three cases. Median times between filing the suit, the injunction, first ruling, and appellate ruling were 7, 239, and 478 days respectively. In 80.6% of the 98 suits in which the specific medicines could be identified, at least one drug did not belong to any publicly funded list of medicines. This could indicate that lawsuits demanding "essential" drugs were motivated not only by problems in procurement, distribution, and dispensing of medicines but also by non-inclusion of medicines on official lists. Most of the medicines demanded through lawsuits were for conditions involving the cardiovascular and nervous systems.
TL;DR: In this article, the authors analyzed the relationship between physical fitness and functional capacity in 78 residents of long-stay institutions for low-income elderly located in five regions of Brazil and found that the greater the degree of dependency in institutionalized elderly, the lesser their strength and GPF level.
Abstract: This study analyzed the relationship between physical fitness and functional capacity in 78 residents of long-stay institutions for low-income elderly located in five regions of Brazil. The majority of the sample consisted of women, and mean age was 77.4 years (SD = 7.9). Physical fitness was assessed with the AAHPERD test, adjusted for institutionalized elderly. The Katz scale was used for functional capacity. The five components of physical fitness rated fair for flexibility, coordination, agility, and aerobic endurance and good for strength. The mean general physical fitness (GPF) index was fair. According to the findings, the greater the degree of dependency in institutionalized elderly, the lesser their strength and GPF level; meanwhile, better coordination and agility are associated with greater independence for performing activities of daily living. The results can contribute to appropriate physical exercise programs for maintenance and/or recovery of functionality.
TL;DR: A review of Flexner's life and work, various representations of the Flexnerian model in the Brazilian literature on health education, and possibilities for interpreting the FBM as an intriguing and peculiar political mythology are analyzed.
Abstract: In Brazil, there appears to be no doubt concerning the evils caused by Abraham Flexner, his Report, and the Flexnerian Biomedical Model (FBM), conceived and promoted by private foundations and linked to the U.S. health-industrial complex. In this article, I submit the above proposition to a rigorous critical inquiry. I begin with an overview of Flexner's life and work. I then review various representations of the Flexnerian model in the Brazilian literature on health education, after which I identify inconsistencies, contradictions, and omissions by comparing the original Report to elements referring to the FBM. Finally, contrasting historical sources and imaginary representations, I analyze possibilities for interpreting the FBM as an intriguing and peculiar political mythology.
TL;DR: The adult-equivalent calorie availability levels were higher than the per capita levels, with the largest differences in rural and low-income households, and showed that per capital measurements can underestimate the real calorie availability.
Abstract: This study aims to estimate an adult-equivalent scale for calorie requirements and to determine the differences between adult-equivalent and per capita measurements of calorie availability in the Brazilian population. The study used data from the 2002-2003 Brazilian Household Budget Survey. The calorie requirement for a reference adult individual was based on the mean requirements for adult males and females (2,550kcal/day). The conversion factors were defined as the ratios between the calorie requirements for each age group and gender and that of the reference adult. The adult-equivalent calorie availability levels were higher than the per capita levels, with the largest differences in rural and low-income households. Differences in household calorie availability varied from 22kcal/day (households with adults and an adolescent) to 428kcal/day (households with elderly individuals), thus showing that per capital measurements can underestimate the real calorie availability, since they overlook differences in household composition.
TL;DR: In Alta Floresta and Tangará da Serra, the percentage increases in the relative risk of hospitalization for respiratory diseases in children were significant for the whole year and for the dry season with 3-4 day lags, and the PM2.5 from the burning of biomass increased hospitalizations for respiratory Diseases in children and the elderly.
Abstract: The objective of the study is to evaluate the effect of the daily variation in concentrations of fine particulate matter (diameter less than 2.5µm - PM2.5) resulting from the burning of biomass on the daily number of hospitalizations of children and elderly people for respiratory diseases, in Alta Floresta and Tangara da Serra in the Brazilian Amazon in 2005. This is an ecological time series study that uses data on daily number of hospitalizations of children and the elderly for respiratory diseases, and estimated concentration of PM2.5. In Alta Floresta, the percentage increases in the relative risk (%RR) of hospitalization for respiratory diseases in children were significant for the whole year and for the dry season with 3-4 day lags. In the dry season these measurements reach 6% (95%CI: 1.4-10.8). The associations were sig-nificant for moving averages of 3-5 days. The %RR for the elderly was significant for the current day of the drought, with a 6.8% increase (95%CI: 0.5-13.5) for each additional 10µg/m3 of PM2.5. No as-sociations were verified for Tangara da Serra. The PM2.5 from the burning of biomass increased hospitalizations for respiratory diseases in children and the elderly.
TL;DR: The high prevalence of recurrent falls was demonstrated and it was emphasized that a multidisciplinary approach is necessary to minimize recurrent falls and their consequences, including osteoporotic fractures.
Abstract: The objective of the study was to estimate the frequency of recurrent falls and identify the main associated risk factors. The BRAZOS is the first epidemiological study performed on a representative sample of the Brazilian population. Anthropometric data, living habits, previous fractures, falls, dietary intake, physical activity and quality of life were evaluated in 2,420 individuals aged 40 and older. Recurrent falls were reported by 15.5% of men and 25.6% of women. Among women, the risk factors significantly associated to recurrent falls were age, previous fracture, sedentary lifestyle, poor quality of life, diabetes mellitus and current use of benzodiazepine. In men, the risk factors were age, poor quality of life, intake of alcoholic beverages, diabetes mellitus, previous fracture and use of benzodiazepine. A greater intake of vitamin D had a protector effect on the risk of recurrent falls. These findings demonstrated the high prevalence of recurrent falls and emphasize that a multidisciplinary approach is necessary to minimize recurrent falls and their consequences, including osteoporotic fractures.
TL;DR: The introduction of VL in Brazilian cities represents a different epidemiological reality from the historical situation and requires new strategies by VL surveillance and control systems, and treatment of cases may help decrease transmission.
Abstract: Cad. Saúde Pública, Rio de Janeiro, 26(4):644-645, abr, 2010 Visceral leishmaniasis (VL) affects 65 countries, with an estimated incidence of 500 thousand new cases and 59 thousand deaths per year. In Brazil, the disease is caused by the protozoan Leishmania infantum chagasi, transmitted by sandflies from genus Lutzomyia, with dogs as the principal source of infection in urban areas. VL is a serious disease with few treatment options, and even with adequate treatment the case fatality rate is some 5%. Historically, VL has been considered a rural endemic, but since the 1980s the disease has undergone gradual urbanization. The first major urban epidemic in the country was in Teresina, Piaui State. Epidemics occurred later in Natal (Rio Grande do Norte) and São Luís (Maranhão), and the disease subsequently spread to other regions of the country. Autochthonous cases were recently described for the first time in the southernmost State of Rio Grande do Sul. The epidemiological panorama leaves no doubt as to the severity of the situation and the unchecked geographic spread of VL. From 1980 to 2008, more than 70 thousand cases of VL were reported in Brazil, with 3,800 deaths. The mean number of cases reported per year increased from 1,601 (1985-1989) to 3,630 (2000-2004), leveling off since then. In the 1990s, only 10% of cases occurred outside the Northeast Region, but in 2007 the proportion reached 50% of cases. From 2006 to 2008, autochthonous transmission of VL was reported in more than 1,200 municipalities (counties) in 21 States. VL is a neglected disease that affects neglected populations. Poverty, migration, unplanned urban settlement, environmental destruction, precarious sanitation and housing, and malnutrition are some of its numerous determinants. The World Health Organization recognizes the lack of sufficient means for its elimination, despite initiatives on the Indian subcontinent, where the disease is transmitted from person to person by vector bites. In this case, treatment of cases may help decrease transmission. However, in Brazil, where the disease is zoonotic, treatment of human cases plays an essentially curative role. The National Program for the Control of Visceral Leishmaniasis bases its strategy on the detection and treatment of human cases, control of domestic reservoirs, and vector control. Still, after years of investment, these measures have proven insufficient to prevent spread of the disease. The introduction of VL in Brazilian cities represents a different epidemiological reality from the historical situation and requires new strategies by VL surveillance and control systems. Visceral leishmaniasis raises many challenges, but the emphasis should be on scientific and technological development and health innovation. More research is needed for the development of new drugs, treatment regimens, and clinical management protocols. Studies on the effectiveness of control measures should be backed by solid methodologies; it is necessary to invest in integrated tactics for structured intervention according to the different transmission scenarios, preferably targeting the areas at highest risk. The production and validation of new diagnostic tests should be highlighted. Studies for effective vaccines to protect individuals and decrease transmission should be prioritized. Research should also be encouraged to solve operational barriers to the implementation of preventive measures. There is still a huge lack of knowledge on VL. However, besides scientific production itself, a broad social commitment is needed to prevent VL from taking a definitive foothold as one more serious health problem in Brazil’s daily urban reality. Geographic spread of visceral leishmaniasis in Brazil EDITORIAL
TL;DR: In this article, the prevalence of geohelminth infections among children in ten Brazilian municipalities with low human development indices (HDI) was estimated by using multilevel logistic regression.
Abstract: Stool surveys were conducted to estimate the prevalence and identify risk factors for geohelminth infections among children in ten Brazilian municipalities with low human development indices (HDI). Socioeconomic and environmental data were obtained from the children's parents or guardians, and stool samples were examined. The proportion of geohelminth infections according to target variables was calculated. Risk factors were evaluated using multilevel logistic regression. Of the 2,523 children, 36.5% were infected with one or more geohelminths (Ascaris lumbricoides, 25.1%; hookworm, 15.3%; Trichuris trichiura, 12.2%). Overall prevalence of geohelminth infections was 45.7% in rural areas and 32.2% in urban areas. Low family income (OR = 1.75; 1.38-2.23), low maternal schooling (OR = 1.69; 1.39-2.06), presence of garbage near the home (OR = 1.50; 1.22-1.84), and number of individuals in the household (OR = 1.41; 1.17-1.71) were associated with infection. In conclusion, geohelminth infections were closely related to socioeconomic conditions, thus emphasizing the importance of targeted public interventions to improve living conditions as part of sustainable prevention.
TL;DR: Support groups and orientation by primary health care for breastfeeding were associated with increased exclusive breastfeeding prevalence and prevalence of exclusive breastfeeding decreased 17% per month in the infant's life.
Abstract: The aim of this study was to assess the association between promotion, protection, and support for breastfeeding in primary health care services and prevalence of exclusive breastfeeding in the first six months of life. A cross-sectional study was conducted in a representative sample of 1,029 mothers of infants younger than six months treated at primary health care facilities in the city of Rio de Janeiro, in southeastern Brazil. Prevalence ratios (PR) were estimated by Poisson regression. Prevalence of exclusive breastfeeding was 58.1%. Factors associated with increased prevalence of exclusive breastfeeding were: white skin color (PR = 1.20; 95%CI: 1.05-1.36); schooling (PR = 1.19; 95%CI: 1.05-1.35); marital status (married or in common-law marriage) (PR = 1.72; 95%IC:1.02-2.90); previous breastfeeding (PR = 1.27; 95%CI: 1.08-1,49); exclusive breastfeeding at the time of hospital discharge (PR = 2.01; 95%CI: 1.20-3.36); group support for the mother (PR = 1.14; 95%CI: 1.01-1.28); and orientation on breastfeeding (PR = 1.20; 95%CI: 1.08-1.33). Prevalence of exclusive breastfeeding decreased 17% per month in the infant's life. Support groups and orientation by primary health care for breastfeeding were associated with increased exclusive breastfeeding prevalence.
TL;DR: In families living in food insecurity, overweight and obesity were frequent; meanwhile, 21% of the children showed height deficit and the authors conclude that food insecurity results not only from quantitative limitations but also from deficient food quality.
Abstract: A population-based cross-sectional study was conducted in Pelotas, Southern Brazil, to assess the prevalence of food insecurity and describe the nutritional status of family members living in this condition. The sample included 1,450 households from the urban area of Pelotas. The six questions of the Food Insecurity Scale (United States Department of Agriculture) were administered to the person in charge of preparing meals in the house. A 12-month recall period was used. If the household was considered insecure, all members were weighed and measured. Prevalence of food insecurity for all families was 11% (95%CI: 9%-13%). In families living in food insecurity, overweight and obesity were frequent; meanwhile, 21% of the children showed height deficit. The authors conclude that food insecurity results not only from quantitative limitations but also from deficient food quality.
TL;DR: For instance, a recent study as mentioned in this paper showed that the risk of morte for a policiais militares and tam-bem maior that entre os agentes dos outros orgaos de seguranca: chega a ser 6,44 vezes o da Guarda Munici-pal e 1,72 em relacao a Policia Civil.
Abstract: populacao masculina da cidade do Rio de Janeiro, e 7,2 vezes as da populacao geral da referida cidade. Ao se fa-zer um cotejo com as taxas do Brasil, sao 7,17 vezes as da populacao masculina e 13,34 vezes as da populacao geral. O risco de morte entre policiais militares e tam-bem maior que entre os agentes dos outros orgaos de seguranca: chega a ser 6,44 vezes o da Guarda Munici-pal e 1,72 em relacao a Policia Civil.Nesse sentido, a obra produz informacoes estra-tegicas visando a subsidiar acoes dos profissionais da corporacao e de seus gestores para adequar a cor-poracao as necessidades atuais da seguranca publica. Sobretudo porque sendo essa a policia que mais mata tambem e a que mais morre como demonstraram as autoras, fatos esses que por si so evidenciam uma po-litica de seguranca equivocada.Ainda faz-nos refletir que a estrategia de combate a criminalidade que aposta no confronto, fracassou, pois os principios da politica de seguranca publica pautados por este nao se encontram com os principios da segu-ranca humana, convertem-se em mortes anunciadas: da populacao civil e desses servidores publicos.
TL;DR: A cohort study of pregnant women in Rio Grande do Sul State, Brazil found insufficient weight gain may still be a public health problem, but excessive gain is becoming a concern that needs immediate attention in prenatal care.
Abstract: In order to describe adequacy of weight gain during pregnancy and its association with pre-pregnancy nutritional status and other factors, a cohort study of pregnant women enrolled at 16-36 weeks of gestation and followed up until delivery was carried out in prenatal care in primary care services in Rio Grande do Sul State, Brazil. Maternal weight was recorded at each prenatal care visit. Weight gain was classified as "adequate," "insufficient" or "excessive" (Institute of Medicine). Poisson regression was used to measure the associations. The sample was comprised of 667 women, and insufficient and excessive weight gain incidences were 25.8% and 44.8%, respectively. Overweight and obese before pregnancy had a significant increased risk of excessive weight gain in pregnancy (RR: 1.75; 95%CI: 1.48-2.07, RR: 1.55; 95%CI: 1.23-1.96, respectively). Women with fewer than six prenatal visits had a 52% increased risk for weight gain below recommended values. Although insufficient weight gain may still be a public health problem, excessive gain is becoming a concern that needs immediate attention in prenatal care.
TL;DR: As tentativas de suicidio foram significativas entre homens desempregados e mulheres donas-de-casa/aposentadas, e houve associacao com outras substâncias em 51,5% dos casos, sendo a frequencia maior entre os homens.
Abstract: This study presents the profile of suicide attempts using intentional overdose with medicines, treated at the Poison Control Center in Londrina, Parana State, Brazil. A retrospective study of cases treated from 1997 to 2007 was performed. Suicide attempts were significant among unemployed men, housewives, and retired women, and there was an association with other substances in 51.5% of the cases, with a higher frequency among men. 51.1% of the men combined the medicine with an alcoholic beverage, while in women, 84.8% of the associations involved other medicines. The most frequent pharmacological groups were tranquilizers (25.5%), antidepressants (17%), anticonvulsants (15%), and NSAIDs (11.9%). Prescribers must evaluate patients correctly before prescribing psychoactive drugs, since this is the pharmacological group most frequently associated with suicide attempts. Awareness-raising campaigns for rational use of medicines and social programs for suicidal patients should also help decrease the frequency of such cases.
TL;DR: Analysis of teenage pregnancy and other risk factors for fetal and infant mortality in the city of Rio de Janeiro, Brazil reaffirm the relevance of social and health policies targeting adolescents, as well as improvements in prenatal care.
Abstract: This article analyzes teenage pregnancy and other risk factors for fetal and infant mortality in the city of Rio de Janeiro, Brazil. The study included a sample of births in Rio de Janeiro, and exposure variables were organized hierarchically. For fetal death, the results showed the protective effect of adequate prenatal care, while maternal morbidity increased the risk. For neonatal death, adequate prenatal care and female gender in the newborn were protective factors, while black or brown maternal skin color, history of stillbirth, maternal morbidity, and physical aggression during the index pregnancy increased the risk. Low birth weight and prematurity were corroborated as determinants of fetal and neonatal death. Risk of post-neonatal death was highest with increased parity, intra-gestational morbidity, and low birth weight. Teenage pregnancy itself was an independent factor for post-neonatal death. The findings reaffirm the relevance of social and health policies targeting adolescents, as well as improvements in prenatal care.
TL;DR: It is concluded that postpartum depression prevalence in the sample was higher than the average international rates, but that depressive symptoms do not impair mother-infant interaction and maternal sensitivity is affected by socio-cognitive and emotional factors.
Abstract: Postpartum depression is a highly prevalent disorder that can interfere in the mother-infant relationship. This study aims to evaluate the prevalence of postpartum depression in our sample to compare mother-infant interaction in depressed and non-depressed mothers and to assess the relationship between maternal depression, social support, attachment style, and emotional availability. Participants were pregnant women who planned to deliver at the University of Sao Paulo Hospital between December 2006 and December 2008. Postpartum depression prevalence in our sample was 28%. No difference was found in emotional availability between depressed and non-depressed mothers. There was a positive correlation between maternal sensitivity and education, and between sensitivity and some dimensions of social support and attachment styles. We conclude that postpartum depression prevalence in our sample was higher than the average international rates, but that depressive symptoms do not impair mother-infant interaction. Maternal sensitivity is affected by socio-cognitive and emotional factors.
TL;DR: It is concluded that the verbal autopsy method can be a valuable tool for improving the Mortality Information System, allowing the identification of causes of death and improving data completeness.
Abstract: Ill-defined causes of death can be related to problems in access to health services or poor quality of medical care and are indicators of data quality in the Mortality Information System (MIS). A sample of municipalities (counties) was selected from the Northeastern Macro-Region of Minas Gerais State, Brazil, with the aim of investigating deaths from ill-defined causes and deaths not reported to the Mortality Information System in 2007, using the verbal autopsy technique. The method allowed identifying 87% of the causes of investigated deaths, of which 17% (n = 37) were due to violent causes. At the end of the study, of the 779 investigated deaths, 9.5% (n = 74) were due to external causes found outside the MIS. The distribution of causes was similar when comparing deaths reported (versus not reported) to the MIS for natural causes, but different when external causes were included. The article concludes that the verbal autopsy method can be a valuable tool for improving the MIS, allowing the identification of causes of death and improving data completeness.
TL;DR: In this paper, an analysis of individual claims for provision of medicines brought by users of the Unified National Health System (SUS) against the State of Rio de Janeiro, Brazil, in the year 2005, is presented.
Abstract: Based on an analysis of individual claims for provision of medicines brought by users of the Unified National Health System (SUS) against the State of Rio de Janeiro, Brazil, in the year 2005, this study aims to discuss the action and behavior of the court system in ruling on these suits. The study adopted a semi-qualitative exploratory documental research design, analyzing key aspects related to the claims, such as type of medication claimed by the plaintiff, wording of the court rulings, and the key elements used by judges in trying the cases. According to the analysis of the lawsuits and the concepts of judicialization and official standardization of medicines, the study concludes that when ruling on the provision of medicines, the court system grants the claims as submitted without considering the standardization of medicines adopted by the Ministry of Health, thus exercising excessive court intervention in health policy.
TL;DR: The article presents the contributions by SEM to epidemiology, highlighting the need for an a priori theoretical model for improving the study of epidemiological questions from a new perspective.
Abstract: Structural equation modeling (SEM) is an important statistical tool for evaluating complex relations in several research areas. In epidemiology, the use and discussion of SEM have been limited thus far. This article presents basic principles and concepts in SEM, including an application using epidemiological data analysis from a study on the determinants of cognitive development in young children, considering constructs related to organization of the child's home environment, parenting style, and the child's health status. The relations between the constructs and cognitive development were measured. The results showed a positive association between psychosocial stimulus at home and cognitive development in young children. The article presents the contributions by SEM to epidemiology, highlighting the need for an a priori theoretical model for improving the study of epidemiological questions from a new perspective.
TL;DR: A cross-sectional epidemiological study developed including participants aged 30 years and older living in Ribeirão Preto, São Paulo State, Brazil showed high diabetes mellitus prevalence and identified associated factors amenable to intervention.
Abstract: To identify diabetes mellitus prevalence and associated factors, a cross-sectional epidemiological study was developed including participants aged 30 years and older living in Ribeirao Preto, Sao Paulo State, Brazil. Using three-stage cluster sampling, probability weights were applied, resulting in a weighted sample of 2,197 participants. Diabetes mellitus diagnosis was based on previous medical history or World Health Organization (WHO) cut-offs after oral glucose tolerance test. To investigate associated factors, crude and adjusted prevalence ratios were estimated by points and confidence intervals, using Poisson regression. Diabetes mellitus prevalence was 15.02%. After adjusting for potential confounding, factors associated with diabetes mellitus in the final model were: age; family history of diabetes mellitus; waist hip ratio; waist height ratio; number of medicines taken; and use of outpatient services. The results showed high diabetes mellitus prevalence and identified associated factors amenable to intervention.
TL;DR: Falls were twice as frequent in women, individuals with rheumatism or back problems, and those on psychoactive medication, while the findings to encourage further discussion on the health of elderly residents in long-term care institutions were welcomed.
Abstract: This study focuses on the occurrence of falls and related factors among elderly individuals living in long-term care institutions in Pelotas, Rio Grande do Sul State, Brazil. A structured questionnaire on demographic characteristics, morbidity, use of psychoactive drugs, and occurrence of falls was used. In December 2006, all 21 long-term care institutions for the elderly registered in the city were contacted, and 19 agreed to participate. A total of 377 elderly were identified, but 96 were unable to answer the questionnaire and 38 refused to answer. Most of the 243 elderly in the sample were women (72.8%), and mean age was 77.7 years (SD = 8.9). Nearly one-third of the sample (32.5%) had suffered at least one fall in the previous year. Falls were twice as frequent in women, individuals with rheumatism or back problems, and those on psychoactive medication. The aim is for the findings to encourage further discussion on the health of elderly residents in long-term care institutions.