Eduardo Mota

Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): Objectives and Design

Although low- and middle-income countries still bear the burden of major infectious diseases, chronic noncommunicable diseases are becoming increasingly common due to rapid demographic, epidemiologic, and nutritional transitions. However, information is generally scant in these countries regarding chronic disease incidence, social determinants, and risk factors. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) aims to contribute relevant information with respect to the development and progression of clinical and subclinical chronic diseases, particularly cardiovascular diseases and diabetes. In this report, the authors delineate the studys objectives, principal methodological features, and timeline. At baseline, ELSA-Brasil enrolled 15,105 civil servants from 5 universities and 1 research institute. The baseline examination (2008-2010) included detailed interviews, clinical and anthropometric examinations, an oral glucose tolerance test, overnight urine collection, a 12-lead resting electrocardiogram, measurement of carotid intima-media thickness, echocardiography, measurement of pulse wave velocity, hepatic ultrasonography, retinal fundus photography, and an analysis of heart rate variability. Long-term biologic sample storage will allow investigation of biomarkers that may predict cardiovascular diseases and diabetes. Annual telephone surveillance, initiated in 2009, will continue for the duration of the study. A follow-up examination is scheduled for 2012-2013.

Dengue and dengue hemorrhagic fever epidemics in Brazil: what research is needed based on trends, surveillance, and control experiences?

Dengue epidemics account annually for several million cases and deaths worldwide. The high endemic level of dengue fever and its hemorrhagic form correlates to extensive domiciliary infestation by Aedes aegypti and multiple viral serotype human infection. This study analyzed serial case reports registered in Brazil since 1981, describing incidence evolutionary patterns and spatial distribution. Epidemic waves followed the introduction of every serotype (DEN 1 to 3), and reduction in susceptible individuals possibly accounted for decreasing case frequency. An incremental expansion of affected areas and increasing occurrence of dengue fever and its hemorrhagic form with high case fatality were noted in recent years. In contrast, efforts based solely on chemical vector control have been insufficient. Moreover, some evidence demonstrates that educational measures do not permanently modify population habits. Thus, as long as a vaccine is not available, further dengue control depends on potential results from basic interdisciplinary research and intervention evaluation studies, integrating environmental changes, community participation and education, epidemiological and virological surveillance, and strategic technological innovations aimed to stop transmission.

Major Expansion Of Primary Care In Brazil Linked To Decline In Unnecessary Hospitalization

In 1994 Brazil launched what has since become the worlds largest community-based primary health care program. Under the Family Health Program, teams consisting of at least one physician, one nurse, a medical assistant, and four to six trained community health agents deliver most of their services at community-based clinics. They also make regular home visits and conduct neighborhood health promotion activities. This study finds that during 1999-2007, hospitalizations in Brazil for ambulatory care-sensitive chronic diseases, including cardiovascular disease, stroke, and asthma, fell at a rate that was statistically significant and almost twice the rate of decline in hospitalizations for all other causes. In municipalities with high Family Health Program enrollment, chronic disease hospitalization rates were 13 percent lower than in municipalities with low enrollment, when other factors were held constant. These results suggest that the Family Health Program has improved health system performance in Brazil by reducing the number of potentially avoidable hospitalizations.

Infant mortality in Brazil during recent periods of economic crisis

OBJECTIVE To analyze time trends in infant mortality in Brazil during a recent period of economic crisis (1980-1998). METHODS Time-series study based on the Ministry of Healths Mortality Information System, IBGE Foundation and Funda o Nacional de Sa de (National Health Institute database. Serial parameters were described using autoregressive integrated moving average (ARIMA) models, and the association between infant mortality rates and a number of determinants was evaluated using Spearman correlation coefficients. RESULTS Infant mortality showed a declining trend (-59.3%) and a strong correlation with most of the indicators analyzed. However, only correlations between infant mortality rate and total pregnancy and birth rates presented a significant difference between the two decades. CONCLUSIONS Variations in pregnancy rate were the main cause for the persistent decline in infant mortality in the 1980s. In the subsequent period, causes related to living conditions, especially healthcare, may have been more important.

Trends in primary health care-sensitive conditions in Brazil: the role of the Family Health Program (Project ICSAP-Brazil)

BackgroundThis study describes trends in hospital admission rates for primary healthcare-sensitive conditions (PHCSC) in Brazil. ObjectivesTo evaluate the impact of increased primary healthcare availability through the implementation of the Family Health Program (FHP) on PHCSC admissions rates at the national, regional, and state-levels between 1999 and 2007. Research DesignAn ecologic panel data study was used and a fixed effects multivariate negative binomial model was used to estimate the association of PHCSC admission rate and FHP controlling for other relevant covariates. ResultsIt was shown that, at the national level, PHCSC hospital admissions declined by 24%—over 2.5 times more rapidly than the decline in hospitalizations for all other (non-PHCSC) conditions. Greater reductions in the PHCSC admission rates when compared with the non-PHCSC admission rates were also observed when the data were divided by regions and states. Regression models showed that at the state level the greater the FHP coverage, the less was the PHCSC hospital admissions even when controlling for confounding variables. ConclusionsThe results of this study have important implications for the healthcare model in countries that base their national health systems on primary healthcare. This is the first study to evaluate the association between FHP coverage and PHCSC admissions rates in all the Brazilian states over a long and relevant period for the consolidation of FHP in the country.

Caracterização dos usuários e dos serviços prestados por Centros de Atenção Psicossocial Infanto-Juvenil

This study aimed to provide an understanding of diagnosis, demographic characteristics, and treatment procedures for children and adolescents attending Psychosocial Care Centers (CAPSIS) in Brazil, 2003. It was a cross-sectional descriptive study using secondary data. The analysis considered three groups of variables related to: (a) the nature of the services; (b) patient profile; and (c) types of care. Seven CAPSIS that had recorded their procedures during all 12 months of 2003 participated in the study. The units involved treated 1,456 individuals, 62.8% of whom were males 11-13 years of age. Nearly half (49.3%) were treated in non-intensive care. The most frequent diagnoses were behavioral and emotional disorders (44.5%). There was no record of treatment related to use of psychoactive substances. The proportion of severe disorders was 19.4%. The CAPSIS operate in similar fashion to older outpatient units, but treat a variety of problems, creating a record according to types of activities. These services fill a historical gap in public mental health care for children and adolescents.

Análise dos registros de leishmaniose visceral pelo método de captura-recaptura

OBJETIVO: Analisar o numero de casos, obitos, incidencia e letalidade e estimar a subnotificacao da leishmaniose visceral, bem como a cobertura dos sistemas nacionais de informacoes. METODOS: Foram analisados casos confirmados de leishmaniose visceral com base nos sistemas: Sistema de Informacao de Agravos de Notificacao (Sinan), Sistema de Informacoes sobre Mortalidade (SIM) e Sistema de Informacoes Hospitalares (SIH), nos anos de 2002 e 2003. As variaveis utilizadas no relacionamento para identificacao dos pares foram: nome do paciente, nome da mae, data de nascimento, sexo, municipio de residencia e endereco. Para calculo das estimativas aplicou-se a metodologia de captura-recaptura, utilizando a formula de Chapman. RESULTADOS: A subnotificacao estimada para casos de leishmaniose visceral no Sinan, em relacao ao SIH e SIM, foi 42,2% e 45,0%, respectivamente. A subnotificacao estimada de obitos no SIM foi 53,0% e 46,5%, quando comparada com Sinan-obitos e SIH-obitos, respectivamente. Comparando o Sinan e o SIH, a incidencia estimada foi de 2,9 por 100.000 habitantes, 70,5% mais alta que a encontrada utilizando somente os dados do Sinan. Da comparacao dos dados do SIM e Sinan-obitos a letalidade estimada de 8%, representou um incremento de 16% da inicialmente registrada no Sinan-obitos. CONCLUSOES: Os resultados mostram elevada subnotificacao estimada de casos e obitos de leishmaniose visceral no Brasil. O relacionamento dos sistemas de informacoes e aplicacao do metodo captura-recaptura permitiram conhecer e melhorar as estimativas epidemiologicas, sendo factivel sua utilizacao nos servicos de saude.

Risk Factors for Developing Nosocomial Infections Among Pediatric Patients

Background: Nosocomial infections (NIs) are important causes of morbidity and mortality in pediatric hospitals. Multiple factors contribute towards exposing children to the risk of infection when hospitalized, and some of them differ from those in adults. Methods: This was a prospective study in a tertiary-level teaching pediatric hospital in Salvador, Bahia, Brazil, conducted from January to July, 2003, to describe the epidemiologic characteristics of NIs. Centers for Disease Control’s standard definitions were used and the data recorded included intrinsic and extrinsic risk factors. Results: We evaluated 808 patients. There were 143 episodes of NI in 124 patients (15.4%). The overall incidence of NI cases was 9.2 per 1,000 patient-days, with higher rates among children aged less than 1 year (P < 0.001) and those with nonsurgical clinical diseases (P < 0.001). Gastrointestinal infections (39.2%) and eye, ear, nose, throat or mouth infections (29.4%) were most common. The factors most closely associated with higher incidence of NI were respiratory disease on admission (incidence density ratio [IDR], 4.0; 95% confidence interval [CI], 2.83–5.72), another disease associated with admission diagnosis (IDR, 3.5; 95% CI, 2.41–5.02), nonsurgical clinical disease (IDR, 5.9; 95% CI, 3.92–8.85) and pediatric intensive care unit residence (IDR, 3.5; 95% CI, 1.91–6.28). The lengths of hospital stay for patients with and without nosocomial infection were, respectively, 14.1 days (SD, 20.5 days) and 5.1 days (SD, 6.6 days) (t = 121.76; P < 0.001). Conclusions: Nosocomial infections are a frequent complication in pediatrics. They are not necessarily related to invasive procedures but certainly are related to a group of factors that have particular characteristics in the pediatric age group.

Análisis multifactorial de los factores de riesgo de bajo peso al nacer en Salvador, Bahia

El presente estudio constituye un analisis multifactorial de los factores de riesgo de bajo peso al nacer en un grupo de recien nacidos en una zona urbana del Brasil. Se incluyeron en el estudio un total de 1 023 nacidos vivos, dados a luz en cuatro maternidades de Salvador, Bahia, entre julio de 1987 y febrero de 1988. Las fuentes de informacion fueron las historias clinicas y las entrevistas con las madres en la maternidad. El analisis se realizo mediante regresion logistica. En el modelo final los factores de riesgo incluidos fueron los siguientes: edad materna menos de 21 anos o mas de 35; edad gestacional menos de 38 semanas; resultado desfavorable del embarazo anterior; intervalo intergenesico previo de 12 meses o menos; tabaquismo; e hipertension. Se presentan los valores del riesgo atribuible poblacional para los factores de riesgo incluidos en el modelo final. Esos factores deben emplearse para detectar a las gestantes con alto riesgo de dar a luz un nino de bajo peso, a las que debe brindarse mayor atencion prenatal.

Estudo de fatores de risco para óbitos de menores de um ano mediante compartilhamento de bancos de dados

In order to identify risk factors for infant mortality (< 1 year of age) in Salvador, Bahia State, Brazil, by means of data bank linkage, a case-control study was performed, selecting individuals from the Mortality Information System (SIM; 2000 and 2001) and the Information System on Live Births (SINASC; 2000). The database linkage or data-sharing technique was used, with the Access 2000 software, version 9.0. Independent variables were collected from the SINASC database. The association between potential risk factors and infant death was evaluated by logistic regression. Prematurity, maternal occupation as a domestic servant, housewife, or student, delivery in public health services, insufficient number of prenatal visits, and low birth weight were predictors of infant death. Linkage revealed missing and incomplete data. Only 40.9% of data were recorded electronically. Despite these limitations, data linkage allowed better use of the two systems and the identification of critical points to further improve their quality.