Iuri da Costa Leite

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.

Perfis de utilização de serviços de saúde no Brasil

Servicos de saude devem responder as demandas populacionais que resultam da conjugacao de fatores sociais, individuais e culturais. Para isso, faz-se necessario o conhecimento do padrao de consumo de servicos de saude. Neste artigo, quatro perfis de consumo de saude foram gerados a partir da aplicacao da tecnica do Grade of Membership (GoM). O modelo teorico de utilizacao de servicos de saude proposto por Andersen serviu como marco de referencia da analise, permitindo que estimativas da demanda por servicos de saude fossem feitas segundo niveis altos e baixos de capacitacao, necessidade e predisposicao para o consumo. Ressalta-se que especial atencao deve ser dada ao grupo de alta necessidade e predisposicao, e baixa capacitacao, que representa 14% da populacao brasileira acima de 14 anos de idade (exceto a regiao Norte) e e composto, predominantemente, por idosos que moram sozinhos e tem alta necessidade de servicos especializados.

Fatores associados à incapacidade funcional dos idosos no Brasil: análise multinível

OBJECTIVE To analyze the influence of demographic, socioeconomic, health, and contextual factors of the Brazilian federation units on the functional disability of the elderly. METHODS Cross-sectional study based on data from the 2003 PNAD (Brazilian National Household Survey), of IBGE (Brazilian Institute of Geography and Statistics) and Ipea (Institute of Applied Economic Research). The sample was composed of 33,515 individuals aged 60 years and older. The dependent variable was functional disability, measured by difficulty in climbing slopes or stairs. The independent variables were divided into two levels: individual (demographic, socioeconomic and health-related characteristics) and contextual (Gini Index and Gross Domestic Product per capita by Brazilian state in 2000). A multinomial and multilevel logistic regression model was utilized in order to estimate the effect of the independent variables on the functional disability of the elderly. RESULTS Functional disability was associated with demographic, socioeconomic and health factors. At the individual level, sex, level of schooling, income, occupation, self-perception of health and chronic diseases were the factors that were most strongly related to functional disability. At the contextual level, income inequality proved to exert an important influence. CONCLUSIONS Self-perception of health is the factor that is most strongly related to the functional disability of the elderly in Brazil, followed by chronic diseases. Sex, occupation, level of schooling and income are also highly associated with it. Actions that approach the main factors associated with functional disability can contribute significantly to the well-being and quality of life of the elderly.OBJETIVO: Analisar a influencia dos fatores demograficos, socioeconomicos, de condicoes de saude e do contexto das unidades da federacao na incapacidade funcional dos idosos. METODOS: Estudo transversal que utilizou dados da Pesquisa Nacional por Amostra de Domicilio (PNAD) de 2003, do Instituto Brasileiro de Geografia e Estatistica (IBGE) e do Instituto de Pesquisa Economica Aplicada (Ipea). A amostra foi constituida de 33.515 individuos com 60 anos ou mais de idade. A variavel dependente foi a incapacidade funcional, mensurada pela dificuldade por subir ladeira ou escada. As variaveis independentes foram divididas em dois niveis: individual (caracteristicas demograficas, socioeconomicas e relativas a saude) e de contexto (Indice de Gini e Produto Interno Bruto per capita por unidade da federacao em 2000). Um modelo de regressao logistica multinomial multinivel foi utilizado para estimar o efeito das variaveis independentes na incapacidade funcional dos idosos. RESULTADOS: A incapacidade funcional foi associada com fatores demograficos, socioeconomicos e de saude. Em nivel individual, o sexo, a educacao, a renda, a ocupacao, a autopercepcao de saude e as doencas cronicas foram os fatores mais fortemente relacionados. Em nivel de contexto, a desigualdade de renda exibiu uma importante influencia. CONCLUSOES: A autopercepcao de saude e o fator mais fortemente relacionado com a incapacidade funcional dos idosos no Brasil, seguida das doencas cronicas. Sexo, ocupacao, escolaridade e renda tambem sao altamente associados. Acoes que abordam os principais fatores associados a incapacidade funcional podem contribuir significativamente para o bem-estar e qualidade de vida dos idosos.

Adolescent fertility behavior: trends and determinants in northeastern Brazil.

Demographic and health surveys identified the trends and determinants of fertility behavior among northeastern Brazilian adolescents in 1986 1991 and 1996. Discrete-time hazard models estimated the probability of a woman having a first birth during adolescence and evaluated individual and environmental factors influencing personal fertility choices. Data showed that the factor most strongly and consistently associated with the probability of giving birth during adolescence was the young womans level of educational attainment. Adolescents who had not attended school beyond the primary level had a higher average incidence of having a first birth by comparison with those who had attained a secondary education. Multivariate analysis revealed that religious affiliation and mass media exposure did not consistently influence adolescent fertility over time. This study suggests that the promotion of education may be the most effective strategy for delaying childbearing among adolescents in northeastern Brazil. In addition the impact of health and family planning programs on teenage fertility needs to be researched further.

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.

Conceituando e mensurando a incapacidade funcional da população idosa: uma revisão de literatura

This article aims to review the main concepts and measures of functional disability currently used in studies focusing on this subject. According to this review, functional disability can be defined as a difficulty or the need for help for performing basic or more complex daily activities necessary for keeping an independent life in the community. As refers to measurement criteria, the studies do not follow a clear-cut standard, varying substantially in relation to scales, dimensions and classifications besides depending directly or indirectly on the kind of available information. A correct method for rating functional disability does not exist at yet. For this reason it is essential that the researchers clearly indicate the concept of functional disability used in the studies and detail, which measures or tools were applied.

Factors associated with sexual and reproductive behavior among adolescents from the Northeast and Southeast regions of Brazil

This article calls attention to factors associated with sexual and reproductive behavior among adolescents from the Northeast and Southeast regions of Brazil. The analyses focus on three dimensions of this process: sexual initiation, use of contraceptives in the first sexual relationship, and fertility. Hierarchical models are implemented, because adolescents selected from the same community are more likely to have similar sexual and reproductive behavior than those from different communities. Level of schooling was the most important risk factor in the three analyses. Girls with 5 or more years of schooling were less likely to have their first sexual relationship during adolescence and more likely to use contraceptive methods in this relationship, besides demonstrating less risk of having children than their counterparts with less than 5 years of schooling.

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.

Assessing regional differences in contraceptive discontinuation, failure and switching in Brazil

BackgroundContraceptive prevalence is relatively high in Brazil (55% among women of reproductive age). However, reversible methods account for less than half of the method mix and widespread differences persist across regions and social groups. This draws attention to the need for monitoring family planning service-related outcomes that might be linked with quality of care. The present study examines the factors associated with method discontinuation, failure and switching among current contraceptive users, with a focus on sub-national assessment.MethodsData for the analysis are drawn from the Brazil Demographic and Health Survey, notably the calendar module of reproductive events. Multilevel discrete-time competing risks hazard models are used to estimate the random- and fixed-effects on the probability of a woman making a specific transition after a given duration of contraceptive use.ResultsContraceptive continuation was found to be highest for the contraceptive pill, the most popular reversible method. Probabilities of abandonment while in need of family planning and of switching to another method were highest for injections. Failure, abandonment and switching were each higher among users in the Northeast region compared to the more prosperous Southeast and South.ConclusionFindings point to seemingly important disparities in the availability and quality of family planning and reproductive health care services across regions of the country. Expanding access to a range of contraceptive methods, improving knowledge among health agents of contraceptive technologies and increasing medical supervision of contraceptive practice may be considered key to expanding quality reproductive health care services for all.

Evaluation of antenatal peregrination in a sample of postpartum women in Rio de Janeiro, Brazil, 1999/2001

The access to obstetric care in the city of Rio de Janeiro, Brazil, was evaluated in this study. The aim of this article was to determine the social, demographic and obstetric factors associated with the antenatal search for health services, in a sample of 6,652 postpartum women. It was observed that 1/3 of patients have to search for services in more than one hospital, not uncommonly in 3 or more. It is important to consider that only 1/5 of these patients are transferred by ambulance. The factors associated with this peregrination were: place of residence, birth weight, age, skin color, marital status and residence in places where garbage is not picked up. There was no association with schooling; Kotelchuck modified index, obstetric risk, water source and residence in slums.