Alitéia Santiago Dilélio

Prevalence of falls in elderly in Brazil: a countrywide analysis

We conducted a cross-sectional study of a sample of 6,616 elderly living in urban areas of 100 municipalities in 23 Brazilian states, who responded to questions on the occurrence of falls in the 12 months prior to the interview, and occurrence of fractures due to the falls. The prevalence of falls among the elderly was 27.6% (95%CI: 26.5-28.7). Among those reporting falls, 11% had suffered fractures as a result. Of the elderly, 36% had received guidance about the precautions necessary to prevent falls, and about 1% had required surgery. Falls were associated with female gender, older age, low socioeconomic status, obesity and sedentary lifestyles. The prevalence of falls differed significantly between the North and other regions of Brazil. The study shows a high prevalence of falls, and underlines the need for preventive strategies targeting modifiable risk factors.

Características da utilização de serviços de atenção básica à saúde nas regiões Sul e Nordeste do Brasil: diferenças por modelo de atenção

In view of the emphasis on primary care for the health system and the consolidation of Family Healthcare Strategy, it is important that information on attended demand be updated to assist in administration of the Unified Health System (UHS). The study compared the profile of attended demand in basic healthcare units (BHU) of two care models (traditional and family health) in 240 BHU of seven states of the South and the Northeast. Collected on a prepared form, all patients attended in a single day were processed with the PACOTAPS application. 26,019 patients were attended, 52% in the South and 48% in the Northeast; one third in Traditional BHU and 67% in BHU of FHP. The highest proportion of patients attended was females aged between 15 and 49 (36%), with significant differences between the models, being higher in BHU of FHP. The second highest proportion was people aged 50 or older (30%), significantly higher in Traditional BHU. The most commonly registered procedures were basic nursing cases (33%), with higher proportion in Traditional BHCU. The proportion of medical appointments was 22%, double in Traditional BHCU. The profile of the demand reflected the differences between the ongoing care models in the country and may provide the organization of work processes in basic care.

Promoção, prevenção e cuidado da hipertensão arterial no Brasil

OBJETIVO: Estimar a prevalencia de acoes de promocao, prevencao e cuidado da hipertensao arterial em adultos e identificar sua associacao com estado descompensado de hipertensao. METODOS: Estudo epidemiologico transversal de base populacional realizado por meio de entrevista com 12.324 adultos, de 20 a 59 anos, em 100 municipios brasileiros. As variaveis independentes, consideradas como promocao, prevencao e cuidado, foram: ter recebido orientacoes sobre a manutencao do peso ideal e sobre atividade fisica; ter consultado um medico e ter realizado eletrocardiograma no ultimo ano. Pressao arterial acima de 140/90 mmHg foi considerada estado descompensado, sendo a variavel dependente para a avaliacao da qualidade do cuidado. RESULTADOS: Do total, 16,3% (n = 2.004) referiram diagnostico medico de hipertensao. As maiores prevalencias de hipertensao foram observadas na categoria de idade de 50 a 59 anos, concentradas nas regioes Sudeste e Centro-Oeste. Mais da metade (66,1%) esteve em consulta medica por hipertensao no ultimo ano, da qual metade (52,4%) realizou eletrocardiograma. Dos hipertensos que tiveram sua pressao arterial aferida na entrevista (74,6%), menos da metade (42,4%) apresentava cifras tensionais descompensadas. CONCLUSOES: Nao houve associacao entre haver consultado medico no ultimo ano e cifras tensionais descompensadas. A proporcao de hipertensos descompensados foi significativamente menor entre os que foram orientados para manter o peso ideal, realizar atividade fisica e os que fizeram eletrocardiograma. Ser do sexo masculino, ter idade acima de 40 anos e habitar na regiao Sul mostraram-se associados a estado descompensado da hipertensao.OBJECTIVE To estimate the prevalence of promotion, prevention and arterial hypertension care actions in adults and to identify their association with decompensated hypertension. METHODS A population-based cross-sectional epidemiological study was conducted by interviewing 12,324 adults aged from 20 to 59 years, in 100 Brazilian cities. The independent variables considered as promotion, prevention and hypertension care were as follows: to have received guidance on ideal weight maintenance and physical activity practice; to have consulted a doctor; and to have had an electrocardiogram performed in the previous year. A blood pressure higher than 140/90 mm/Hg was considered to be decompensated, being the dependent variable adopted to assess quality of care. RESULTS Of all participants, 16.3% (n = 2,004) reported a medical diagnosis of hypertension. The highest prevalences of hypertension were observed in the 50 to 59 year age group, primarily in the Southeast and Center-West regions. More than half (66.1%) of participants had a medical consultation about hypertension in the previous year, of which half (52.4%) had an electrocardiogram. Of all those with hypertension who had their blood pressure measured during interview (74.6%), less than half (42.4%) had decompensated values. CONCLUSIONS There was no association between having consulted a doctor in the previous year and decompensated blood pressure values. The proportion of decompensated hypertensive participants was significantly lower among those who had received guidance on ideal weight maintenance and physical activity practice and those who had had an electrocardiogram performed. The following factors were associated with decompensated hypertension: to be male, to be aged more than 40 years and to live in the South region.

Prevalência de transtornos psiquiátricos menores em trabalhadores da atenção primária à saúde das regiões Sul e Nordeste do Brasil

Mental health problems are among the most prevalent conditions in health workers. We evaluated the prevalence of minor psychiatric disorders and associated factors among primary healthcare workers. The study design was cross-sectional and services-based, in 240 primary healthcare units in 41 municipalities (counties) with more than 100 thousand inhabitants in seven States in the South and Northeast regions of Brazil. A total of 4,749 primary healthcare workers were interviewed, and prevalence of minor psychiatric disorders was 16%, with no statistical differences according to region or primary care model. The rate was higher in community health workers and other workers with secondary education (18%) and lower in health professionals with university training (10%); while physicians (15%) and nurses and nurse technicians (14.6%) were in an intermediate situation (p < 0.001). Occupational characteristics showed the strongest association with the occurrence of minor psychiatric disorders according to the adjusted analysis, suggesting that their reduction requires improvements in work conditions in primary healthcare and in the management of the Unified National Health System.

Atividade física no deslocamento em adultos e idosos do Brasil: prevalências e fatores associados

Prenatal care is a key indicator of the quality of health services. The current study aimed to evaluate the correlation between data from prenatal care cards and maternal recall in the city of Rio Grande, Rio Grande do Sul State, Brazil. The cross-sectional study included all mothers from 2010 who had received prenatal care. Interviews were conducted with a pre-coded questionnaire in the maternity hospital. Of the 2,288 mothers interviewed, 1,228 (53.7%) had the prenatal care card with them and thus comprised the group for comparison. The analysis used kappa correlation and confidence interval. The variables six or more prenatal visits, clinical breast and gynecological examination, two blood tests, VDRL, HIV serology, urine test, and tetanus vaccination showed statistically significant differences between annotated and maternal recall data (p ≤ 0.001). Adequacy of prenatal care based on the guidelines of the Program for Humanization of Prenatal Care (PHPN) was 23.9% according to information provided by the patients and 4.4% according to information recorded on the prenatal cards (p ≤ 0.001). The prenatal care card showed underreporting, which limited the quality assessment of prenatal care.A assistencia pre-natal e um indicativo da qualidade dos servicos de saude. Esse estudo objetivou avaliar a concordância entre os dados do pre-natal da memoria materna e do cartao da gestante no Municipio do Rio Grande, Rio Grande do Sul, Brasil. Estudo transversal incluindo todas puerperas do ano de 2010 que realizaram pre-natal. As entrevistas e a coleta dos dados do cartao ocorreram nas maternidades. Das 2.288 puerperas entrevistadas, 1.228 (53,7%) portavam o cartao da gestante, sendo a comparacao realizada nesse grupo. A analise foi feita utilizando-se o teste de concordância kappa e o intervalo de confianca. A realizacao de seis ou mais consultas de pre-natal, exame das mamas e ginecologico, dois exames de sangue, VDRL, anti-HIV, urina e a vacinacao antitetânica demonstraram diferenca estatistica entre os dados referidos e anotados (p ≤ 0,001). A adequacao do pre-natal pelo indice do Programa de Humanizacao do Pre-Natal (PHPN) nos dados referidos foi de 23,9% e de 4,4% nos dados anotados (p ≤ 0,001). Observamos um sub-registro no cartao da gestante, o qual influenciou negativamente na avaliacao da qualidade do pre-natal.

Gestão do trabalho, da educação, da informação e comunicação na atenção básica à saúde de municípios das regiões Sul e Nordeste do Brasil

Decentralization in Brazils Unified National Health System is challenging the management capability at the local level. Municipalities are required to operate health teams, provide infrastructure, technology, and supplies for the health services, and organize the work process. An epidemiological survey assessed the management of work, education, information, and communication in primary care services in 41 municipalities with more than 100,000 inhabitants each in the Northeast and South of the country. Health professionals and administrators were insufficiently trained for their daily responsibilities, and the infrastructure and management tools were deficient. Precarious work contracts (lack of formal job stability) for health workers is a serious problem in Brazils primary care system. The work supervision was weakly linked to health care and planning. Continuing education for the health team was limited, and health information focused only on collection of data to send to the State and Federal management levels. Thus far health communication has been ineffective as a tool to connect primary care managers and professionals to the population and society.A descentralizacao das acoes no Sistema Unico de Saude requer competencias especificas para a gestao municipal. As demandas incluem o gerenciamento de equipes de trabalho, estrutura fisica e tecnologica, e organizacao de insumos e estrategias. Por meio de inquerito epidemiologico estudou-se a gestao do trabalho, da educacao, da informacao e da comunicacao na atencao basica a saude de 41 municipios com mais de 100 mil habitantes das regioes Sul e Nordeste do Brasil. Evidenciou-se uma escassa profissionalizacao dos gestores e limitacoes importantes das estruturas e instrumentos de gestao. A precarizacao do trabalho e um problema relevante na atencao basica. A supervisao do trabalho esta pouco direcionada ao planejamento e as praticas de saude. A educacao permanente de trabalhadores se limita a particularidades das acoes de saude. Geralmente, a informacao em saude no âmbito municipal se restringe a coleta e transferencia de dados as esferas estadual e federal. Ja a comunicacao nao se constitui em uma estrategia efetiva de vinculacao entre gestores, trabalhadores, populacao e controle social.

Insegurança alimentar no Nordeste e Sul do Brasil: magnitude, fatores associados e padrões de renda per capita para redução das iniquidades

O artigo analisa a inseguranca alimentar em domicilios urbanos com criancas menores de sete anos de idade. Por meio de estudo transversal localizou-se, nas areas de abrangencia de unidades basicas de saude, 5.419 domicilios na Regiao Nordeste e 5.081 na Regiao Sul do Brasil. A inseguranca alimentar foi avaliada usando-se a Escala Brasileira de Inseguranca Alimentar. A prevalencia de inseguranca alimentar moderada ou grave foi 22,9% no Nordeste e 7,5% no Sul. Em ambas as regioes, na analise ajustada, a maior probabilidade de inseguranca alimentar moderada e grave foi identificada em domicilios chefiados por mulheres, com cor da pele materna preta e parda/mestica, com menor escolaridade materna, menor renda familiar per capita e beneficiarios do Bolsa Familia. A inseguranca alimentar moderada ou grave seria reduzida em 59,5% no Nordeste e em 45,4% no Sul, com uma renda familiar per capita minima de R

Promotion, prevention and arterial hypertension care in Brazil.

175,00 ao mes. O aumento da renda familiar dos mais pobres e a melhor focalizacao do Bolsa Familia sao essenciais para a diminuicao da inseguranca alimentar no pais.This article addresses food insecurity among urban Brazilian families with children under seven years. A cross-sectional study in areas covered by primary health care centers identified 5,419 families in the Northeast and 5,081 in the South of the country. Food insecurity was assessed by the Brazilian Food Insecurity Scale. Prevalence of moderate or severe food insecurity was 22.9% in the Northeast and 7.5% in the South. According to the adjusted analysis, increased likelihood of moderate or severe food insecurity was associated with families headed by women, black or brown maternal skin color, low maternal education, low family income, and enrollment in the Bolsa Família program (conditional income transfer). Moderate or severe food insecurity would be reduced by 59.5% in the Northeast and 45.4% in the South with a per capita income of at least BRL 175.00 per month. Increased family income for the poorest families and better targeting of Bolsa Família are essential for reducing food insecurity in the country.

Padrões de utilização de atendimento médico-ambulatorial no Brasil entre usuários do Sistema Único de Saúde, da saúde suplementar e de serviços privados

OBJETIVO: Estimar a prevalencia de acoes de promocao, prevencao e cuidado da hipertensao arterial em adultos e identificar sua associacao com estado descompensado de hipertensao. METODOS: Estudo epidemiologico transversal de base populacional realizado por meio de entrevista com 12.324 adultos, de 20 a 59 anos, em 100 municipios brasileiros. As variaveis independentes, consideradas como promocao, prevencao e cuidado, foram: ter recebido orientacoes sobre a manutencao do peso ideal e sobre atividade fisica; ter consultado um medico e ter realizado eletrocardiograma no ultimo ano. Pressao arterial acima de 140/90 mmHg foi considerada estado descompensado, sendo a variavel dependente para a avaliacao da qualidade do cuidado. RESULTADOS: Do total, 16,3% (n = 2.004) referiram diagnostico medico de hipertensao. As maiores prevalencias de hipertensao foram observadas na categoria de idade de 50 a 59 anos, concentradas nas regioes Sudeste e Centro-Oeste. Mais da metade (66,1%) esteve em consulta medica por hipertensao no ultimo ano, da qual metade (52,4%) realizou eletrocardiograma. Dos hipertensos que tiveram sua pressao arterial aferida na entrevista (74,6%), menos da metade (42,4%) apresentava cifras tensionais descompensadas. CONCLUSOES: Nao houve associacao entre haver consultado medico no ultimo ano e cifras tensionais descompensadas. A proporcao de hipertensos descompensados foi significativamente menor entre os que foram orientados para manter o peso ideal, realizar atividade fisica e os que fizeram eletrocardiograma. Ser do sexo masculino, ter idade acima de 40 anos e habitar na regiao Sul mostraram-se associados a estado descompensado da hipertensao.OBJECTIVE To estimate the prevalence of promotion, prevention and arterial hypertension care actions in adults and to identify their association with decompensated hypertension. METHODS A population-based cross-sectional epidemiological study was conducted by interviewing 12,324 adults aged from 20 to 59 years, in 100 Brazilian cities. The independent variables considered as promotion, prevention and hypertension care were as follows: to have received guidance on ideal weight maintenance and physical activity practice; to have consulted a doctor; and to have had an electrocardiogram performed in the previous year. A blood pressure higher than 140/90 mm/Hg was considered to be decompensated, being the dependent variable adopted to assess quality of care. RESULTS Of all participants, 16.3% (n = 2,004) reported a medical diagnosis of hypertension. The highest prevalences of hypertension were observed in the 50 to 59 year age group, primarily in the Southeast and Center-West regions. More than half (66.1%) of participants had a medical consultation about hypertension in the previous year, of which half (52.4%) had an electrocardiogram. Of all those with hypertension who had their blood pressure measured during interview (74.6%), less than half (42.4%) had decompensated values. CONCLUSIONS There was no association between having consulted a doctor in the previous year and decompensated blood pressure values. The proportion of decompensated hypertensive participants was significantly lower among those who had received guidance on ideal weight maintenance and physical activity practice and those who had had an electrocardiogram performed. The following factors were associated with decompensated hypertension: to be male, to be aged more than 40 years and to live in the South region.

Advice for salt, sugar and fat intake habits among adults: a national-based study

Indicators of supply, access, and use of healthcare are helpful for characterizing services, planning activities, and organizing demand. This study describes patterns of use of outpatient care and the associations with demographic and socioeconomic factors, morbidity, population size of the municipality and region, and administrative and financial classification of the provider. This was a population-based cross-sectional study with a sample of 12,402 Brazilian adults from 20 to 59 years of age living in urban areas of 100 municipalities from five regions. Prevalence of outpatient care in the three months prior to the interview was 34.6%. The Brazilian Unified National Health System (SUS) accounted for more than half (53.6%) of the cases, health insurance was used by 34% of the sample, and out-of-pocket services 12.4%, regardless of region, population size, and morbidity profile. Patterns of use of health services remain socially determined, resulting from the supply, demographic and socioeconomic characteristics, and health profile of users.Indicators of supply, access, and use of healthcare are helpful for characterizing services, planning activities, and organizing demand. This study describes patterns of use of outpatient care and the associations with demographic and socioeconomic factors, morbidity, population size of the municipality and region, and administrative and financial classification of the provider. This was a population-based cross-sectional study with a sample of 12,402 Brazilian adults from 20 to 59 years of age living in urban areas of 100 municipalities from five regions. Prevalence of outpatient care in the three months prior to the interview was 34.6%. The Brazilian Unified National Health System (SUS) accounted for more than half (53.6%) of the cases, health insurance was used by 34% of the sample, and out-of-pocket services 12.4%, regardless of region, population size, and morbidity profile. Patterns of use of health services remain socially determined, resulting from the supply, demographic and socioeconomic characteristics, and health profile of users.