Dalia Elena Romero

Avaliação da qualidade das variáveis epidemiológicas e demográficas do Sistema de Informações sobre Nascidos Vivos, 2002

This study evaluates the quality of data in the Brazilian Live Births Information System (SINASC), focusing on the methodological clarity of documentation and adequate data completeness and consistency at the national, regional, and State levels in 2002. The variables analyzed were: skin color/race of newborn, maternal schooling, maternal marital status, maternal occupation, maternal age, prenatal visits, live births, stillbirths, and birth weight. For most of the variables, SINASC shows good data completeness and consistency, but there were serious problems with the quality of data on previous children and maternal occupation. Related to race, there were some methodological problems in the definition and incomplete filling-in for the Federal District (Brasilia) and the States of Sao Paulo, Bahia, and Sergipe. Statistical analysis confirmed a significant association between data completeness and indicators of poverty and inequality. The study showed that improvements in SINASC data quality could make this system a good epidemiological source for identifying risk factors and socioeconomic conditioning factors.

Pesquisa Nacional de Saude no Brasil: concepcao e metodologia de aplicacao

The National Health Survey is a household-based nationwide survey carried out by the Ministry of Health in partnership with the Brazilian Institute of Geography and Statistics. The scope of the survey is to establish the health status and lifestyles of the population - as well as how they look after their health - with regard to access and use of services, preventive actions, continuity of care, and health care financing. The sample size is 80,000 households and enables the calculation of some indicators at different geographic levels, namely states, capitals, metropolitan and rural areas. The questionnaire is divided into three parts. The first two are answered by one resident and include questions on the household characteristics and on the social and economic level and health status of all inhabitants. The individual questionnaire is answered by an adult (aged 18 years or more), selected with equal probability among the adult residents, and focuses on morbidity and lifestyle. For this individual, measurements of weight, height, waist circumference and blood pressure are taken, as well as laboratory exams to characterize the lipid profile and blood glucose level, as well as determine the urine sodium content. The laboratory exams are taken in a subsample of 25% of the census sectors selected.

Healthy life expectancy in Brazil: applying the Sullivan method

The objective of this study is to present the method proposed by Sullivan and to estimate the healthy life expectancy using different measures of state of health, based on information from the World Health Survey carried out in Brazil in 2003. By combining information on mortality and morbidity into a unique indicator, simple to calculate and easy to interpret, the Sullivan method is currently the one most commonly used for estimating healthy life expectancy. The results show higher number of healthy years lost if there is a long-term disease or disability that limits daily activities, regardless of the difficulty in performing such activities or the severity of the functional limitations. The two measures of healthy life expectancy adjusted by the severity of functional limitation show results very similar to estimates based on the perception of state of health, especially in advanced age. It was also observed, for all measures used, that the proportion of healthy years lost increases significantly with age and that, although females have higher life expectancy than males, they live proportionally less years in good health.

Avaliação da qualidade das variáveis sócio-econômicas e demográficas dos óbitos de crianças menores de um ano registrados no Sistema de Informações sobre Mortalidade do Brasil (1996/2001)

This study aimed to evaluate the quality of socioeconomic and demographic data in the Brazilian Mortality Information System (SIM), in relation to infant mortality. The article assesses the systems potential for monitoring inequalities in infant mortality in various States in the country. Accessibility, timeliness, methodological clarity, incompleteness, and consistency were explored as quality indicators. Selected variables were: race, birth weight, gestational age, medical care, parity, and maternal schooling, age, and occupation. The study also reviewed the systems working documentation and the scientific literature on infant mortality. Proportions of data incompleteness were calculated by region and State, identifying factors that might influence (in)completeness using logistic regression. Despite the databases accessibility and the relevance of most of its variables, the system has serious quality problems: confusing instructions in the information manual concerning missing data, misclassification of maternal occupation, lack of data on the informants race/ethnicity, and high proportions of incomplete information. The system does not appear to be a reliable source for monitoring, evaluating, and planning measures to minimize infant health inequalities.

Diferenciais de gênero no impacto do arranjo familiar no status de saúde dos idosos brasileiros

Analisam-se os diferenciais por genero na relacao do arranjo familiar com o status de saude de pessoas com 65 anos ou mais, incorporando tambem fatores socioeconomicos e sociodemograficos. Utilizam-se dados da PNAD de 1998. Foram desenvolvidos diversos modelos de regressao logistica para duas variaveis dependentes: auto-avaliacao da saude e declaracao de doencas. Os fatores explicativos (area rural/urbana, idade, renda per capita, analfabetismo, arranjo familiar e condicao no domicilio) foram incorporados sequencialmente para avaliar as mudancas da inter-relacao. Encontrou-se que, embora as mulheres tenham mais desvantagem quanto a declaracao de doencas, a auto-avaliacao da condicao de sua saude e relativamente similar a dos homens. Os diferenciais de genero no padrao de arranjo familiar dos idosos sao em parte responsaveis pela desvantagem no status de saude das mulheres. Conclui-se que a formulacao de politicas para o melhoramento do status de saude do idoso deve considerar a existencia de importantes diferencas de genero no padrao da estrutura e arranjo de suas familias. Existe necessidade de maior disponibilidade de inqueritos para idosos, que permitam aprofundamento na relacao entre saude do idoso, genero e familia.

Crisis económica y mortalidad infantil en Latinoamérica desde los años ochenta

En este trabajo realizado con informacion de nueve paises latinoamericanos, se encontraron evidencias de la asociacion entre crisis economica y mortalidad infantil durante las ultimas decadas. En primer lugar, se hace referencias a los aportes anteriores relacionados con el tema y se constata la necesidad de mas investigaciones con periodos de corto plazo. De seguido, se describe el deterioro y las desigualdades entre los paises segun la evolucion de los indicadores socio-economicos seleccionados y la evolucion del cociente de mortalidad infantil. Los hallazgos del analisis estadistico muestran que la mortalidad infantil esta asociada negativamente con mudanzas economicas de corto plazo. Se observo correlacion negativa y significativa entre el ritmo de decrecimiento del CMI y el crecimiento de la pobreza. El impacto de la crisis economica de los ochenta tuvo diferente intensidad entre los paises considerados, siendo que la desigualdad del ingreso aparece como una de las explicaciones mas plausibles.In the present study, based on data from nine Latin American countries, we found evidence of an association between the economic crisis and infant mortality during the last decades. The paper initially review previous studies on this issue and shows the need for a greater research focus on shorter time intervals. We then describe the deterioration and unequal conditions among the countries based on trends in selected social and economic indicators and the evolution of infant mortality rates. According to our statistical analysis, infant mortality bore an inverse association to short-term economic variations. We also found a significant and negative correlation between decreasing infant mortality rates and increasing poverty. The economic crisis displayed effects of varying intensity among the countries we analyzed, with social inequality appearing as the most probable explanatory variable.

Increased Hospitalizations for Neuropathies as Indicators of Zika Virus Infection, according to Health Information System Data, Brazil

Neurologic manifestations of Zika infection must be adequately recognized and treated; our study methods can be used for monitoring and warning systems.

Diferenciais geográficos, socioeconômicos e demográficos da qualidade da informação da causa básica de morte dos idosos no Brasil

This study identifies geographic, demographic, and socioeconomic differences in the quality of data on underlying causes of death in the Brazilian elderly population. We used three quality indicators: the proportion of ill-defined causes, the proportion of unspecified causes, and the two proportions combined. We analyzed the main ill-defined and unspecified causes and the association between these indicators and individual characteristics on death certificates (DC) and characteristics of the municipalities. Unspecified causes exceed ill-defined causes, and both increase with age. Schooling, race, size of municipality, and per capita GDP were associated with quality of data (especially with ill-defined as compared to unspecified causes). Having received medical care decreased the odds of cause of death being recorded as ill-defined and increased the odds of unspecified records. Programs to improve quality of information on death certificates should focus on ill-defined and unspecified causes in the elderly.

Avoidability of deaths from chronic illnesses in elderly individuals in São Paulo, Brazil

Avoidable causes of death have become an important indicator for evaluating health services. Such deaths would not occur if there were adequate prevention, early diagnosis, and treatment and the adoption of appropriate technologies. This article analyzes the pattern and magnitude of avoidable causes of death for the principal causes of death among elderly individuals up to 74 years of age, by gender, in Sao Paulo State, Brazil. The study further estimated the impact of avoidable causes of death on life expectancy among the elderly, and 62.5% of the deaths among elderly up to 74 years in Sao Paulo were due to these causes. The principal avoidable causes of death constituted 82.6% of all avoidable deaths, featuring hypertensions and tobacco-associated tumors. Life expectancy at 60 would increase by 20% if these deaths were avoided. Male excess mortality was observed in nearly all of the avoidable causes of death analyzed here, which could be related to greater exposure to risk factors and less use of health services by men. Prevention and health promotion measures should take these sharp gender differences into account.Avoidable causes of death have become an important indicator for evaluating health services. Such deaths would not occur if there were adequate prevention, early diagnosis, and treatment and the adoption of appropriate technologies. This article analyzes the pattern and magnitude of avoidable causes of death for the principal causes of death among elderly individuals up to 74 years of age, by gender, in São Paulo State, Brazil. The study further estimated the impact of avoidable causes of death on life expectancy among the elderly, and 62.5% of the deaths among elderly up to 74 years in São Paulo were due to these causes. The principal avoidable causes of death constituted 82.6% of all avoidable deaths, featuring hypertensions and tobacco-associated tumors. Life expectancy at 60 would increase by 20% if these deaths were avoided. Male excess mortality was observed in nearly all of the avoidable causes of death analyzed here, which could be related to greater exposure to risk factors and less use of health services by men. Prevention and health promotion measures should take these sharp gender differences into account.

Metodologia integrada de acompanhamento de políticas públicas e situação de saúde: o SISAP-Idoso

Resumo O artigo trata da estrategia de construcao do Sistema de Indicadores de Saude e Acompanhamento de Politicas do Idoso (SISAP-Idoso). O Sistema pretende articular a producao de informacoes em saude com a decisao politico-institucional, de modo a servir como instrumento de gestao em saude do idoso. Seu foco e suprir a necessidade de informacoes para o planejamento e o controle de politicas e programas dos gestores municipais do Sistema Unico de Saude (SUS). Apresentam-se as metodologias de criacao da Matriz Conceitual por Dimensoes de Saude e da Matriz Conceitual para Acompanhamento de Politicas e Programas. A primeira sistematiza um painel de indicadores para o diagnostico da situacao de saude da populacao idosa, procedimento sem o qual nao e possivel planejar adequadamente acoes em saude. A segunda seleciona indicadores para monitorar a implementacao e avaliar os resultados de politicas e programas de saude do idoso. O Sistema se mostra uma importante ferramenta de suporte da formulacao e acompanhamento de programas de saude, principalmente no nivel municipal. Alem disso, e uma poderosa ferramenta de controle social e de empoderamento da populacao. A incorporacao plena do SISAP-Idoso depende da consolidacao do uso de informacao e de indicadores no processo de politicas publicas.