Isabel Cristina Martins de Freitas

O perfil do idoso de baixa renda no Município de São Carlos, São Paulo, Brasil: um estudo epidemiológico

This study focuses on the health profile of the elderly population in Sao Carlos, Sao Paulo State, Brazil, in 2003. The study population consisted of a sample over 60 years of age (n = 523) registered with the Family Health Program and the Unified National Health System. Point and interval prevalence of disabilities and chronic non-communicable diseases and cognitive status were estimated (95%CI). The study population was predominantly female with low education; 24.8% lacked any kind of retirement pension; 43.6% presented a low level of social integration; 46.7% required some form of help for 1 to 3 routine activities; 74.9% presented 1 to 5 chronic non-communicable diseases; and 56.2% scored under 24 on a cognitive test. Some 87.0% had sought health care and 22.4% required some kind of inpatient care. The results confirmed the need for improved professional training, adequacy of health services, and effective public policy to provide qualified health care for the elderly population.

Evolução de condicionantes socioeconômicas da saúde na infância na cidade de São Paulo (1984-1996)

OBJETIVO: Descrever a evolucao de condicionantes socioeconomicas da saude na infância, com base nas informacoes extraidas de dois inqueritos domiciliares realizados nos anos de 1984/85 e 1995/96, na cidade de Sao Paulo, SP. METODOS: Foram estudadas amostras probabilisticas da populacao entre zero e 59 meses de idade: 1.016 criancas em 1984/85 e 1.280 criancas em 1995/96. Os inqueritos apuraram a renda per capita mensal das familias e o numero de anos de escolaridade das maes das criancas. As rendas nominais foram deflacionadas segundo o Indice Nacional de Precos ao Consumidor e expressas em valores de outubro de 1996. RESULTADOS: Embora os indicadores socioeconomicos apurados no ultimo inquerito ainda estejam muito distantes da situacao ideal, a media da renda familiar dobra entre os inqueritos e a escolaridade materna aumenta em 1,5 anos. Rendas inferiores a meio salario-minimo per capita sao reduzidas a metade e virtualmente desaparece o analfabetismo materno. Ainda assim, intensifica-se no periodo a concentracao da renda. CONCLUSOES: Os aumentos de renda e de escolaridade sao superiores aos relatados para a populacao brasileira em geral, o que poderia decorrer de declinios seletivos da fecundidade nos estratos mais pobres da populacao de Sao Paulo. A influencia das mudancas na renda familiar e na escolaridade materna sobre a evolucao de diferentes indicadores do estado de saude das criancas da cidade e examinada em artigos subsequentes.

Prevalência de sobrepeso e obesidade e fatores associados em escolares de área urbana de Chilpancingo, Guerrero, México, 2004

This study aimed to investigate the prevalence rates for overweight and obesity among Mexican schoolchildren, identifying factors associated with the outcomes. A cross-sectional study was conducted in a sample consisting of 700 schoolchildren. Prevalence rates were calculated according to age and gender, and odds ratios were estimated by point and intervals, using multivariate logistic regression. Overweight and obesity prevalence were 28.1% and 13.7%, respectively. Risk factors for overweight were: mothers schooling (in years); eating while studying or watching TV; scores for risk food items > or = 12 points; sedentary activities > or = 1.6 hours/day, and birth weight > or = 2,890 grams. Obesity risk factors were similar to those related to overweight. Higher frequency of sport activities was detected as a protective factor in both outcomes. The associated factors for overweight and obesity highlighted the focus for health programs to prevent chronic diseases in this population, for which risk factors can already be identified in childhood.

Prevalência de diabetes mellitus e identificação de fatores associados em adultos residentes em área urbana de Ribeirão Preto, São Paulo, Brasil, 2006: Projeto OBEDIARP

To identify diabetes mellitus prevalence and associated factors, a cross-sectional epidemiological study was developed including participants aged 30 years and older living in Ribeirão Preto, São 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.

Variabilidade na aferição de medidas antropométricas: comparação de dois métodos estatísticos para avaliar a calibração de entrevistadores

Estudos que incluem medidas antropometricas exigem, alem da padronizacao de tecnicas de afericao, o emprego de metodos estatisticos para a avaliacao de erros de mensuracao. OBJETIVO: Comparar duas tecnicas estatisticas para avaliar a calibracao de entrevistadores, em treinamento para a afericao de medidas antropometricas. METODOLOGIA: Treze entrevistadores participaram da fase de treinamento, que foi programado de modo que, em cada sessao, sub-grupos de entrevistadores realizassem duas afericoes de medidas de peso e duas de altura em voluntarios (em media, 10 voluntarios/sessao). Ao todo, foram realizadas seis sessoes para a afericao das medidas de peso e onze para a afericao das medidas de altura. Para as medidas de peso foram utilizadas balancas eletronicas e, para as de altura, estadiometros de parede. Para avaliar a calibracao, dois metodos estatisticos foram comparados: a) o coeficiente de correlacao intraclasse (CCI) e b) a precisao e a exatidao das afericoes, segundo Habicht. RESULTADOS: Os entrevistadores foram submetidos, em media, a duas sessoes para a calibracao das medidas de peso e a tres sessoes para a calibracao das medidas de altura, sendo a precisao atingida antes da exatidao. Os valores dos respectivos CCIs indicaram medicoes fortemente concordantes desde a primeira sessao. CONCLUSAO: O metodo de Habicht apresentou melhor desempenho que o CCI, pois, alem do calculo da precisao, indicou a magnitude da divergencia das afericoes realizadas pelos entrevistadores, em relacao as do supervisor (exatidao).

Padrões de consumo de alimentos e fatores associados em adultos de Ribeirão Preto, São Paulo, Brasil: Projeto OBEDIARP

This study aimed to identify and analyze correlates of dietary patterns in residents of Ribeirao Preto, Sao Paulo State, Brazil. This was a cross-sectional study including both men and women aged > 30 years (n = 930, weighted sample = 2,197). Factor analysis was applied to identify food consumption patterns, using a semi-quantitative questionnaire. Four patterns were identified: (a) obesogenic: associated with more physical activity, more schooling, and age < 40 years; (b) healthy: associated with female gender, individuals without overweight, older adults, central obesity, more physical activity, and higher socioeconomic status; (c) mixed: without overweight, female gender, and younger adults; and (d) popular: associated with absence of hypercholesterolemia and lower family income. The results highlight the need to encourage eating healthy foods in order to prevent chronic non-communicable diseases.

Consumo de frutas e hortaliças por adultos em Ribeirão Preto, SP

OBJECTIVE To assess fruit and vegetable intake by adults and identify sociodemographic and life style variables associated with this intake. METHODS A population-based cross-sectional study was performed in the urban area of the city of Ribeirão Preto, Southeastern Brazil, in 2006. Sample was selected using three-stage cluster sampling, with census tracts as primary units. Sample was comprised of 930 participants aged 30 years and more and the design effect was considered in data analysis. Fruit and vegetable intake was based on a semi-quantitative food frequency questionnaire, using mean scores of frequency of fruit and vegetable intake, daily intake and minimum intake of such foods as indicators. The independent variables analyzed were as follows: age group, marital status, level of education, per capita household income, nutritional status, smoking and physical activity. Mean scores of frequency of intake were estimated by point and 95% confidence intervals. Prevalence ratios were also estimated by point and 95% confidence intervals to analyze association, using Poisson regression. Linear trend tests were applied, adopting a 5% confidence level. RESULTS Only 24% of men and 38% of women met the minimum recommendation for fruit and vegetable intake; there was a positive association with age and per capita income. Women with a higher level of education and men who lived with a female partner consumed more fruits and vegetables than others. Physical activity, smoking and nutritional status were not associated with the minimum recommended fruit and vegetable intake. CONCLUSIONS Socioeconomic factors have an important influence on fruit and vegetable intake and, as these are subject to intervention, they can contribute to the adoption of healthy eating habits.OBJETIVO: Avaliar o consumo de frutas e hortalicas por adultos e identificar variaveis sociodemograficas e de estilo de vida associadas ao consumo desses alimentos. METODOS: Estudo transversal, de base populacional, realizado na area urbana de Ribeirao Preto, SP, em 2006, com amostra selecionada por conglomerados, em tres estagios, tendo como unidade primaria o setor censitario. A amostra foi composta por 930 participantes com 30 anos e mais; na analise de dados levou-se em consideracao o efeito de desenho. O consumo de frutas e hortalicas baseou-se em questionario de frequencia semiquantitativo, utilizando-se como indicadores os escores medios de frequencia de consumo de frutas e hortalicas, consumo diario e consumo minimo desses alimentos. As variaveis independentes analisadas foram: faixa etaria, estado marital, escolaridade, renda familiar per capita, estado nutricional, tabagismo e atividade fisica. Medias dos escores de frequencia de consumo foram estimadas por pontos e por intervalos com 95% de confianca. Para o estudo de associacao, razoes de prevalencias foram estimadas por pontos e por intervalos com 95% de confianca, utilizando-se regressao de Poisson. Testes de tendencia linear foram aplicados, adotando-se nivel de significância de 5%. RESULTADOS: Apenas 24% dos homens e 38% das mulheres atenderam a recomendacao minima do consumo de frutas e hortalicas; observou-se associacao positiva com a idade e renda per capita. Mulheres com maior escolaridade e homens que viviam com a companheira consumiam mais frutas e hortalicas que os demais. Atividade fisica, tabagismo e estado nutricional nao apresentaram associacao com o consumo minimo recomendado de frutas e hortalicas. CONCLUSOES: Fatores socioeconomicos tem importante influencia sobre o consumo de frutas e hortalicas e, por serem passiveis de intervencao, podem contribuir para a adocao de habitos alimentares saudaveis.

Impact of the Haemophilus influenzae type b vaccination program on HIB meningitis in Brazil

This study aimed to evaluate the impact of vaccination against Haemophilus influenzae type b (HIB) in Brazil on the morbidity, mortality, and case fatality of HIB meningitis, using the Ministry of Health database and population data from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística--IBGE). Impact was evaluated through a time series analysis (1983-2002), using regression forecasting (RF) by dividing the time series into two periods: (a) historical (1983-1998) and (b) validation (1999-2002). Impact of the vaccination was positive, although more significant for incidence and mortality than for case fatality rates.

Saúde, nutrição e classes sociais: o nexo empírico evidenciado em um grande centro urbano, Brasil

The relationship between social class and nutritional status, although frequently presumed true, has scarcely ever been studied empirically. The health and nutritional status of a sample of children from different social classes in the city of S. Paulo (Brazil) are studied by means of an on operational classification of social class. Through the analysis of the height for age distribution normal growth - and, therefore, favourable health status - eas found only among the burgeoisie and the small-burgeoisie, these two classes together constituting about 30% of the total population. Significant divergences from an expected anthropometric standard were found among all the segments of the working-class population. Differences in income and schooling among the classes corroborate the empirical link found between social class and health and nutritional status.Embora frequentemente assumida como verdadeira, a relacao entre classe social e estado de saude e nutricao raramente tem sido estudada no plano empirico. Adotando-se proposta classificatoria que permite a identificacao operacional do conceito de classe social em sociedades de organizacao complexa, procurou-se estabelecer e comparar o estado de saude e nutricao de uma amostra das criancas da cidade de Sao Paulo pertencentes a distintas classes sociais. A partir da observacao da distribuicao do indice altura/idade, evidenciou-se crescimento normal - e portanto condicoes otimas de saude e nutricao - apenas entre as criancas pertencentes a burguesia e a pequena burguesia, as quais correspondem a cerca de 30% da populacao. Diferencas significantes (p < 0,01) em relacao a um padrao esperado de alturas de criancas bem nutridas foram encontrados para o proletariado ligado ao setor de servicos, para o proletariado ligado a producao e transporte de mercadorias e para o subproletariado. Diferencas de renda e de acesso a escolaridade entre as classes sociais consubstanciam o nexo empirico evidenciado entre condicao de classe e estado de saude e nutricao.The relationship between social class and nutritional status, although frequently presumed true, has scarcely ever been studied empirically. The health and nutritional status of a sample of children from different social classes in the city of S. Paulo (Brazil) are studied by means of an on operational classification of social class. Through the analysis of the height for age distribution normal growth--and, therefore, favourable health status--as found only among the burgeoisie and the small-burgeoisie, these two classes together constituting about 30% of the total population. Significant divergences from an expected anthropometric standard were found among all the segments of the working-class population. Differences in income and schooling among the classes corroborate the empirical link found between social class and health and nutritional status.

Mortalidade por doenças do aparelho circulatório no município de Ribeirão Preto - SP, de 1980 a 2004

INTRODUCTION In terms of epidemiologic transition, century-long trend studies may act as subsidies for health management hypotheses. OBJECTIVE Identify mortality rate pattern for diseases of the circulatory system (DCS) in Ribeirão Preto, SP (RP-SP), in the period between 1980 and 2004. METHODS The number of deaths due to DCS were obtained from the Mortality Information System (SIM). Populational estimates for RP-SP - taking gender, age group, and calendar years into account - were obtained from the Brazilian Institute of Geography and Statistics (IBGE). Specific mortality rates were calculated on yearly basis according to gender and age group in 10-year intervals starting at 30 years of age. The trend analysis was conducted through polynomial regression models for time series. Significance level was < 0.05. RESULTS Specific mortality rates due to DCS increased with age both among males and females, being higher among males in the 40 to 49-year-old range. After that, figures were comparable, although at 80-year-old age groups data for females showed to be higher than that for males in some years of the series. Along the study period, significant reduction was observed for mortality rates among both males and females, and for all age ranges from those causes (p<0.001). CONCLUSIONS Mortality rate pattern due to DCS in RP-SP was similar to that found in developed areas, which helped formulate hypotheses on the likely protection factors that may explain the observed decline.