Andreia Ferreira de Oliveira

Transição epidemiológica e o estudo de carga de doença no Brasil

No Brasil, a transicao epidemiologica nao tem ocorrido de acordo com o modelo experimentado pela maioria dos paises desenvolvidos. Velhos e novos problemas em saude coexistem, com predominância das doencas cronico-degenerativas, embora as doencas transmissiveis ainda desempenhem um papel importante. Neste estudo, os diferenciais, em relacao ao padrao epidemiologico, sao descritos para o Brasil e grandes regioes, para o indicador de saude dos estudos da carga de doenca, o DALY. Entre os principais resultados encontrados, para o Brasil, destaca-se que o grupo das doencas nao-transmissiveis, infecciosas/parasitarias/maternas/perinatais/nutricionais, e das causas externas representaram, respectivamente, 66,3%, 23,5% e 10,2% da carga total de doenca estimada. A utilizacao do indicador DALY propicia a identificacao de prioridades em funcao do perfil epidemiologico, facilitando a tomada de decisoes e destinacao adequada de recursos por parte dos gestores.

Global burden of disease attributable to diabetes mellitus in Brazil

Type II diabetes mellitus accounts for 90% of all cases of diabetes, and its inclusion in health evaluation has shown that its complications have a considerable impact on the populations quality of life. The current article presents the results of the Global Burden of Disease Study in Brazil for the year 1998, with an emphasis on diabetes mellitus and its complications. The indicator used was disability-adjusted life years (DALY), using a discount rate of 3%. In Brazil, ischemic heart disease, stroke, and diabetes accounted for 14.7% of total lost DALYs. Brazil showed a higher proportion of years lived with disability (YLDs) among total DALYs for diabetes as compared to other countries. Retinopathy and neuropathy were the complications that contributed most to YLDs. According to forecasts, diabetes mellitus will have an increasing impact on years of life lost due to premature death and disability in the world, shifting from the 11th to 7th cause of death by 2030. It is thus urgent to implement effective measures for prevention, early diagnosis, counseling, and adequate follow-up of patients with diabetes mellitus.

Aspects of tobacco attributable mortality: systematic review

The objective of the article was to assess methodologies published and applied in calculating mortality attributable to smoking. A review of the literature was made for the period 1990 to 2006, in the electronic databases MEDLINE and LILACS. A total of 186 studies were found, which measured mortality based on calculating the smoking-attributable risk. Of these, a total of 41 were selected. The studies that were carried out in the United States and Canada presented a more standard methodology and reported smoking attributable mortality to be 18%-23%, with male mortality being 25%-29% and female mortality 14%-17%. The variations can be attributed to methodological differences and to different estimates of the main tobacco-related illnesses.

Comparação das informações sobre as prevalências de doenças crônicas obtidas pelo suplemento saúde da PNAD/98 e as estimadas pelo estudo Carga de Doença no Brasil

In this study, prevalence estimates of five chronic disease cirrhosis, depression, diabetes, chronic rhenal insufficiency and tuberculosis based on the 1998 PNAD Health Supplement were compared to those obtained by the Brazilian Global Burden of Disease Project. These estimates were based on systematic literature review as well as on available data set of morbidities. The results show that PNAD presented higher number of cases for depression and Chronic rhenal insufficiency while the prevalence rates estimated by Brazilian Global Burden of Disease Project were higher for cirrhosis, diabetes and tuberculosis.

Estudo da validação das informações de peso e estatura em gestantes atendidas em maternidades municipais no Rio de Janeiro, Brasil

The main objectives of this article are the assessment of agreement between measure-based and report-based information on weight and height, besides the identification of the main characteristics related to 150 pregnant women who could report (versus could not report) their pre-gestational weight, weight at delivery, and height. According to the results, report-based information on previous weight is close to the measure-based information (Pearson coefficient correlation 0.96 and intra-class correlation 0.92; p < 0.05), with the same occurring for weight at delivery (Pearson coefficient correlation 0.96 and intra-class correlation 0.95; p < 0.05). Nevertheless, linear regression analysis detects that this relationship is troublesome for the height variable (beta0 = 45.5 and beta1 = 0.71; p < 0.05), and therefore the report-based information for height must be used cautiously when the measure-based values are not available. In relation to the characterization of the group of pregnant women who did not inform the three measures (n = 141), these women have the least schooling (63.9%), did not attend or attended fewer prenatal appointments (64.3%), and entered the prenatal program later, when they were already in the second or third trimester (59.3%).

Carga de doença no Brasil e suas regiões, 2008

The current study estimated DALY (disability-adjusted life years), an indicator of burden of disease, for Brazil in 2008. The North and Northeast regions showed higher burden of disease. Chronic noncommunicable diseases predominated in all regions of the country, especially cardiovascular diseases, mental disorders (particularly depression), diabetes, and chronic obstructive pulmonary disease. The study also showed a high burden of homicides and traffic accidents. Brazils epidemiological profile appears even more complex when one considers the non-negligible burden of communicable diseases, maternal and perinatal conditions, and nutritional deficiencies. The analyses allowed a more detailed understanding of the Brazilians populations health status, underscoring the need for crosscutting actions beyond specific health sector policies and greater attention to the quality of information on morbidity and mortality.En este estudio, se estimo DALY (anos de vida ajustados por discapacidad), un indicador de estudios de carga de enfermedad, para Brasil durante 2008. Entre los principales resultados se observan la mayor carga de enfermedad en las regiones Norte y Noreste y la preponderancia de las enfermedades cronicas no transmisibles en todas las regiones del pais; en particular, las enfermedades cardiovasculares, los trastornos mentales, destacandose la depresion, la diabetes y la enfermedad pulmonar obstructiva cronica. Llama tambien la atencion la elevada carga de homicidios y accidentes de trafico. El perfil epidemiologico se revela mas complejo cuando se considera la no despreciable carga de enfermedades transmisibles, condiciones maternas, perinatales y deficiencias nutricionales. Los analisis efectuados hicieron posible conocer el status de salud de la poblacion, lo que pone en evidencia la demanda de acciones que van mas alla de politicas especificas para el area de la salud, asi como la necesidad de ampliar la preocupacion con la calidad de las informaciones sobre morbimortalidad en Brasil.

Burden of disease in Brazil and its regions, 2008

The current study estimated DALY (disability-adjusted life years), an indicator of burden of disease, for Brazil in 2008. The North and Northeast regions showed higher burden of disease. Chronic noncommunicable diseases predominated in all regions of the country, especially cardiovascular diseases, mental disorders (particularly depression), diabetes, and chronic obstructive pulmonary disease. The study also showed a high burden of homicides and traffic accidents. Brazils epidemiological profile appears even more complex when one considers the non-negligible burden of communicable diseases, maternal and perinatal conditions, and nutritional deficiencies. The analyses allowed a more detailed understanding of the Brazilians populations health status, underscoring the need for crosscutting actions beyond specific health sector policies and greater attention to the quality of information on morbidity and mortality.En este estudio, se estimo DALY (anos de vida ajustados por discapacidad), un indicador de estudios de carga de enfermedad, para Brasil durante 2008. Entre los principales resultados se observan la mayor carga de enfermedad en las regiones Norte y Noreste y la preponderancia de las enfermedades cronicas no transmisibles en todas las regiones del pais; en particular, las enfermedades cardiovasculares, los trastornos mentales, destacandose la depresion, la diabetes y la enfermedad pulmonar obstructiva cronica. Llama tambien la atencion la elevada carga de homicidios y accidentes de trafico. El perfil epidemiologico se revela mas complejo cuando se considera la no despreciable carga de enfermedades transmisibles, condiciones maternas, perinatales y deficiencias nutricionales. Los analisis efectuados hicieron posible conocer el status de salud de la poblacion, lo que pone en evidencia la demanda de acciones que van mas alla de politicas especificas para el area de la salud, asi como la necesidad de ampliar la preocupacion con la calidad de las informaciones sobre morbimortalidad en Brasil.

The disease burden attributable to smoking in the state of Rio de Janeiro, Brazil in 2000

INTRODUCTION Smoking is one of the main risk factors for morbidity and mortality. An estimated 59 million (4.4%) disability-adjusted life years were lost due to smoking throughout the world in 2000. OBJECTIVE To estimate the disease burden attributable to smoking in the State of Rio de Janeiro, Brazil, for the year 2000. METHODS Based on estimates of smoking prevalence and relative death risks, the smoking-attributable fraction was calculated for each selected cause, by age and gender. The disease burden attributable to smoking was estimated by multiplying the fractions by the corresponding disability-adjusted life years. RESULTS In the State of Rio de Janeiro, 7% of all disability-adjusted life years were due to smoking. For individuals 30 or more years old, the fraction increased to 10.6% (13.6% in males and 7.5% in females). Chronic obstructive pulmonary disease, ischemic heart disease, cerebrovascular disease, and tracheal, bronchial, and lung cancer accounted for 32.2%, 15.7%, 13.2%, and 11.1% of the estimated total DALYs, respectively, amounting to 72.2% of the smoking-attributable disease burden. DISCUSSION Limitations related to parameter estimates were not unique to this study, and therefore should not compromise the comparability of our results. Outcomes were similar to those obtained in other countries, despite methodological differences. CONCLUSION Smoking is an important risk factor and places a significant disease burden on Rio de Janeiro, Brazil, showing a pattern similar to that observed in high income countries.

Validade de indicadores de atividade física e comportamento sedentário da Pesquisa Nacional de Saúde do Escolar entre adolescentes do Rio de Janeiro, Brasil

This study evaluated the relative validity of physical activity indicators from the questionnaire used in the Brazilian National School-Based Health Survey (PeNSE) in the city of Rio de Janeiro, Brazil, based on a sample of 174 students. The following indicators of weekly physical activity were evaluated: ACTIVE-300MIN (≥ 300 minutes/week); ACTIVE-150MIN (≥ 150 minutes), INACTIVE (no physical activity). Additionally, indicators of sedentary behavior were also assessed, as daily screen time (TV, videogames, and computer). The results from the questionnaire were compared with three 24-hour recalls. The results of ACTIVE-300MIN, ACTIVE-150MIN, and INACTIVE generated by PeNSE showed high accuracy. These indicators performed better than those of sedentary behavior in relation to frequency estimates as well as sensitivity, specificity, and correct classification rate. The indicators of physical activity from PeNSE showed satisfactory relative validity.Analisou-se a validade relativa dos indicadores de atividade fisica do questionario utilizado na Pesquisa Nacional de Saude do Escolar (PeNSE) entre adolescentes da cidade do Rio de Janeiro, Brasil. Foram estudados 174 alunos. Avaliaram-se os seguintes indicadores referentes ao tempo semanal acumulado com a pratica de atividade fisica: ATIVO-300MIN (acumulou 300 minutos ou mais); ATIVO-150MIN (acumulou 150 minutos ou mais); INATIVO (nao praticou atividade fisica). Tambem foram estudados os indicadores de comportamento sedentario referentes ao tempo diario despendido assistindo TV, jogando videogame e usando computador. Foram comparados os resultados do questionario e dos tres recordatorios de 24 horas. Os resultados de ATIVO-300MIN, ATIVO-150MIN e INATIVO gerados pela PeNSE apresentaram alta acuracia. Esses indicadores tiveram melhor desempenho que os de comportamento sedentario, tanto em relacao as estimativas de frequencia quanto em relacao a sensibilidade, especificidade e indice de acuracia. Os indicadores de atividade fisica da PeNSE apresentaram validade relativa satisfatoria.

Fração da carga global do diabetes mellitus atribuível ao excesso de peso e à obesidade no Brasil

OBJETIVO: Estimar a carga global do diabetes mellitus (DM) para o periodo de 2002 a 2003 e calcular, para o mesmo periodo, a fracao do diabetes atribuivel ao excesso de peso e a obesidade para o Brasil e suas regioes. METODOS: A prevalencia de excesso de peso e obesidade por sexo e faixa etaria (> 20 anos) e os riscos relativos (obtidos de estudos internacionais) para o desenvolvimento do DM atribuiveis ao excesso de peso e a obesidade foram utilizados para o calculo da carga global do diabetes. A prevalencia de excesso de peso e obesidade para o Brasil e suas regioes foi obtida da Pesquisa de Orcamento Familiar. Foram calculados, para o DM, os anos de vida ajustados para incapacidade (disability-adjusted life years, DALY) a partir da soma de duas parcelas: anos de vida perdidos por morte prematura (years of life lost, YLL) e anos de vida perdidos devido a incapacidade (years lived with disability, YLD). RESULTADOS: Do total de DALY estimados para o DM no Brasil, 70% provinham dos YLD. Para o Brasil como um todo, 61,8 e 45,4% do DM no sexo feminino foram atribuiveis a excesso de peso e obesidade, respectivamente. No sexo masculino, esses percentuais foram de 52,8 e 32,7%. As maiores fracoes atribuiveis foram encontradas nas regioes Sul, Sudeste e Centro-Oeste e para o grupo populacional entre 35 a 44 anos de idade. CONCLUSAO: Grande parte da carga do diabetes e atribuivel a fatores de risco evitaveis. Medidas voltadas para a prevencao e controle desses fatores de risco, como o excesso de peso e a obesidade, devem estar inseridas na agenda de saude publica brasileira.