José Gomes Bezerra Filho

Uma reflexão sobre o processo de avaliação das pós-graduações brasileiras com ênfase na área de saúde coletiva

Este artigo busca promover uma reflexao acerca dos criterios adotados pelo sistema de avaliacao da Pos-graduacao em curso no pais e seu impacto no âmbito dos diferentes programas, conferindo destaque na analise a area de Saude Coletiva. Ressalta-se, por um lado, a importância que os processos avaliativos tem na consolidacao do sistema de ensino e pesquisa, contribuindo, de modo decisivo, para a promocao e monitoramento da sua qualidade. Em contrapartida, os autores convidam a uma reflexao sobre a concepcao de ciencia subjacente aos criterios adotados e seu impacto no conjunto dos cursos que compoem a pos-graduacao em Saude Coletiva. Para tanto, apontam obstaculos situados em planos distintos e as desigualdades, nao apenas regionais, mas entre instituicoes geograficamente proximas mas que desenvolvem suas praticas em contextos distintos. O texto finaliza indagando sobre a correspondencia entre o percurso historico e os compromissos que marcam a trajetoria da Saude Coletiva e os rumos atuais da avaliacao da pos-graduacao nesse campo de saberes e praticas.

Distribuição espacial da taxa de mortalidade infantil e principais determinantes no Ceará, Brasil, no período 2000-2002

The geographic distribution of health problems and its relationship to potential risk factors has opened a vast field for epidemiological research. The present study aims to identify spatial distribution patterns for the neonatal and post-neonatal components of the infant mortality rate (IMR) in Ceara State, Brazil, and discuss the main socioeconomic, demographic, and healthcare factors contributing to the spatial dependence of these components. This cross-sectional ecological study uses multiple linear regression, in which spatial analysis of the components was obtained through the Moran index. Prenatal, childbirth, and neonatal care as well as improved income distribution are decisive for survival in the first month of life, while other factors related to nutrition, immunization, sanitation, education, and economic status are possible determinants of post-neonatal mortality. Selective healthcare measures are known to play a decisive role in decreasing the IMR. However, structural and inter-sector changes generate the sustainability needed to maintain this indicator on the same level as in developed countries.

Acute kidney injury requiring dialysis in obstetric patients: a series of 55 cases in Brazil

ObjectiveTo investigate the risk factors associated with oliguria and death in obstetric patients with acute kidney injury (AKI).MethodsThe study group included all obstetric patients with AKI, under dialytic treatment, in Hospital Geral César Cals, Fortaleza, Brazil, from January 2000 to December 2006. AKI were classified according to the RIFLE criteria. Univariate and multivariate analysis were performed to investigate the factors associated with oliguria and death.ResultsA total of 55 patients were included. Their average age was 26.2 ± 6.7 years. The main etiologies of AKI were pregnancy-related hypertension (41.8%), HELLP syndrome (40%), puerperal sepsis (14.5%), abruption placentae (9.1%), hemolytic uremic syndrome (9.1%) and thrombotic thrombocytopenic purpura (5.5%). Oliguria was observed in 36 cases (65%). Death occurred in 17 cases (30.9%). Factors associated with oliguria were, diagnosis of HELLP syndrome, hyperbilirubinemia and death. Factors associated with death were, presence of puerperal sepsis, hyperbilirubinemia, hypotension, oliguria and low levels of HCO3.ConclusionAKI is a rare but potential fatal complication in obstetric patients. RIFLE criteria seem to have association with mortality. There are important factors associated with oliguria and death, which must be prompt recognized to the institution of adequate therapeutic measures.

Estudo ecológico sobre os possíveis determinantes socioeconômicos, demográficos e fisiográficos do suicídio no Estado do Rio de Janeiro, Brasil, 1998-2002

Epidemiology has identified violence as a major worldwide public health concern. Suicide is classified as violence. This study analyzes the association between suicide and socio-demographic factors. The methodological design was ecological, using correlation techniques and backward multiple linear regression. Normality of the residuals in the final model was analyzed. Proportional mortality in relation to total deaths was identified as the best outcome for modeling (R(2) = 0.41). The resulting variables were: % Pentecostal religion, % single marital status in the population over 10 years of age, mean years of schooling, altitude of the municipality, % homes without latrines, % population over 10 years of age working in the educational sector, and % population over 10 years with per capita earnings up to one minimum wage. All these variables were statistically significant at 5%. The results support the idea of the influence of extrinsic causal factors in determination of suicide.

Via, homem e veiculo: fatores de risco associados a gravidade dos acidentes de transito

OBJETIVO Analizar las caracteristicas de las victimas, vias y vehiculos involucrados en accidentes de transito y los factores de riesgo de accidentes con ocurrencia de obito. METODOS Estudio de cohorte no concurrente considerando los accidentes de transito en Fortaleza, CE, de enero de 2004 a diciembre de 2008. Se utilizaron datos del Sistema de Informaciones de Mortalidad, del Sistema de Informaciones Hospitalarias y de los bases de datos de Licencia para conducir y Vehiculos del Departamento Estatal de Transito. Tecnicas de relacionamiento deterministico y probabilistico se aplicaron para integrar las bases de datos. Se efectuo el analisis descriptivo de las variables relacionadas con las personas, las vias los vehiculos y el tiempo. Se utilizaron los modelos lineales generalizados en la investigacion de los factores de riesgo para obito por accidente de transito. El ajuste del modelo fue verificado por la tasa de vero-semejanza y el analisis ROC. RESULTADOS Se registraron 118.830 accidentes en el periodo. Predominaron colision/choque (78,1%), atropellamientos (11,9%), choque con obstaculo fijo (3,9%), con motocicletas (18,1%). Ocurrieron obitos en 1,4% de los accidentes. Estuvieron independientemente asociados al obito por accidente de transito: bicicletas (OR= 21,2; IC95% 16,1;27,8), atropellamientos (OR= 5,9; IC95% 3,7;9,2), choque con obstaculo fijo (OR= 5,7; IC95% 3,1;10,5) y accidentes con motociclistas (OR= 3,5; IC95% 2,6;4,6). Los principales factores contribuyentes fueron envolvimiento de una unica persona (OR= 6,6; IC95% 4,1;10,73), presencia de conductores sin licencia para conducir (OR= 4,1; IC95% 2,9;5,5), un unico vehiculo involucrado (OR= 3,9; IC95% 2,3;6,4), sexo masculino (OR= 2,5; IC95% 1,9; 3,3), transito en vias de jurisdiccion federal (OR= 2,4; IC95% 1,8;3,7), horario madrugada (OR= 2,4; IC95% 1,8;3,0), y dia domingo (OR= 1,7; IC95% 1,3;2,2), todas ajustadas de acuerdo con el modelo log-binomial. CONCLUSIONES Las acciones de promocion y prevencion de accidentes en el transito deben enfocarse en accidentes con vehiculos de dos ruedas, que mas frecuentemente involucran una unica persona, sin licencia para conducir, del sexo masculino, en horarios nocturnos, en fines de semana y en las vias donde se desarrollan mayores velocidades.OBJECTIVE To describe the main characteristics of victims, roads and vehicles involved in traffic accidents and the risk factors involved in accidents resulting in death. METHODS A non-concurrent cohort study of traffic accidents in Fortaleza, CE, Northeastern Brazil, in the period from January 2004 to December 2008. Data from the Fortaleza Traffic Accidents Information System, the Mortality Information System, the Hospital Information System and the State Traffic Department Driving Licenses and Vehicle database. Deterministic and probabilistic relationship techniques were used to integrate the databases. First, descriptive analysis of data relating to people, roads, vehicles and weather was carried out. In the investigation of risk factors for death by traffic accident, generalized linear models were used. The fit of the model was verified by likelihood ratio and ROC analysis. RESULTS There were 118,830 accidents recorded in the period. The most common types of accidents were crashes/collisions (78.1%), running over pedestrians (11.9%), colliding with a fixed obstacle (3.9%), and with motorcycles (18.1%). Deaths occurred in 1.4% of accidents. The factors that were independently associated with death by traffic accident in the final model were bicycles (OR = 21.2, 95%CI 16.1;27.8), running over pedestrians OR = 5.9 (95%CI 3.7;9.2), collision with a fixed obstacle (OR = 5.7, 95%CI 3.1;10.5) and accidents involving motorcyclists (OR = 3.5, 95%CI 2.6;4.6). The main contributing factors were a single person being involved (OR = 6.6, 95%CI 4.1;10.73), presence of unskilled drivers (OR = 4.1, 95%CI 2.9;5.5) a single vehicle (OR = 3.9, 95%CI 2,3;6,4), male (OR = 2.5, 95%CI 1.9;3.3), traffic on roads under federal jurisdiction (OR = 2.4, 95%CI 1.8;3.7), early morning hours (OR = 2.4, 95%CI 1.8;3.0), and Sundays (OR = 1.7, 95%CI 1.3;2.2), adjusted according to the log-binomial model. CONCLUSIONS Activities promoting the prevention of traffic accidents should primarily focus on accidents involving two-wheeled vehicles that most often involves a single person, unskilled, male, at nighttime, on weekends and on roads where they travel at higher speeds.

Poor Dental Status and Oral Hygiene Practices in Institutionalized Older People in Northeast Brazil

In this study we describe the dental status and oral hygiene practices in institutionalized older people and identify factors associated with poor dental status. A cross-sectional study was performed in a nursing home in Fortaleza, the capital of Ceará State (northeast Brazil). The number of decayed, missing, and filled teeth (DMFT) was assessed in the residents of the nursing home (n = 167; mean age = 76.6 years). The mean DMFT value was 29.7; the mean number of missing teeth was 28.4. Ninety-three (58.1%) were edentulous. Almost 90% practiced oral hygiene, but only about half used a toothbrush. Only 8% had visited a dentist in the preceding three months. Most of the variables regarding oral hygiene habits (such as the use of toothbrush, frequency of oral hygiene per day, regular tooth brushing after meals) did not show any significant association with the DMFT. In multivariate regression analysis, age, general literacy level, and practice of oral hygiene were independently associated with the DMFT (R2 = 0.13). Institutionalized older people in northeast Brazil have poor dental status, and oral hygiene practices are insufficient. Dental health education is needed focusing on the special needs of this neglected and socioeconomically deprived population to improve their quality of life.

Mortalidade infantil e condições sociodemográficas no Ceará, em 1991 e 2000

OBJECTIVE To assess ecological models to describe infant mortality rate in Ceara (Northeastern Brazil) in two different periods of time. METHODS This was a cross-sectional ecologic study of two years, 1991 and 2000, using non-matching information per municipalities. Estimates on the infant mortality rate of the Instituto de Pesquisas Econômicas Aplicadas (Institute of Applied Economic Research) have been used. For the remaining indicators different sources of the System of Health Information were used. The main risk factors were assessed using multiple linear regression. RESULTS In 1991, the variables that predicted infant mortality rate (R2=0.3575) were: small houses (beta=0.0043; rho=0.010), proportion of inhabitants with tap water in the household (beta=-0.0029; rho=0.024), urbanization rate (beta=0.0032; rho=0.004), fecundity rate (beta=0.0351; rho=0.024), the proportion of children working at 10-14 years (beta=0.0049; rho=0.017), proportion of families with income < 1/2 minimum wage (beta=0.0056; rho=0.000), that can read and write (beta=-0.0062; rho=0.031). In the year 2000, the following possible determinants were identified (R2=0.3236): the proportion of children <2 years of age with malnutrition (beta=0.0064; rho=0.024), proportion of households with adequate sanitation (beta=-0.0024; rho=0.010), proportion of women who could read and write (beta=-0.0068; rho=0.044), expenses on health human resources regarding total health expenses (beta=-0.0024; rho=0.027), proportion of the value of the vegetal production in relation to the total of the state (beta=-0.1090; rho=0.001), intensity of poverty (beta=0.0065; rho=0.002), and ageing index (beta=-0.0100; rho=0.006). CONCLUSIONS Although the variables have not been exactly the same for the evaluated period, determiners of infant mortality have been changing, except for indicators of education, income and sanitation. The overall decrease in fecundity led to a reduction in its discriminating power, and it was replaced by the ageing index. Another tendency observed was the replace of several demographic variables by health care indicators.

Curso técnico de enfermagem do PROFAE-Ceará: a voz dos supervisores

The objective of this qualitative study was to analyze the Technical Nursing Course of the Ceara School of Public Health (Brazil), made possible by the Professionalization Project of Nursing Workers, from the view of supervising nurses in order to know the courses strengths and weaknesses. A focus group made up of 10 course supervisors was carried out in February of 2007. Discourse content analysis made evident that the course allowed for nursing technical competency development. The problematization methodology and the quality of the teaching-learning resources were among its positive aspects. The main difficulties pointed out were related to the course logistics, the lack of municipal support, and limited internship opportunities. We conclude, however, that this educational strategy must be implemented into permanent education as an effective way to ensure professional reflection and significant changes in health care work processes.The objective of this qualitative study was to analyze the Technical Nursing Course of the Ceara School of Public Health (Brazil), made possible by the Professionalization Project of Nursing Workers, from the view of supervising nurses in order to know the courses strengths and weaknesses. A focus group made up of 10 course supervisors was carried out in February of 2007. Discourse content analysis made evident that the course allowed for nursing technical competency development. The problematization methodology and the quality of the teaching-learning resources were among its positive aspects. The main difficulties pointed out were related to the course logistics, the lack of municipal support, and limited internship opportunities. We conclude, however, that this educational strategy must be implemented into permanent education as an effective way to ensure professional reflection and significant changes in health care work processes.

Contact dermatitis associated with Astronium urundeuva (allemão) Engl., a traditional medicinal plant from Brazil

Astronium urundeuva (allemao) Engl. (Anacardiaceae) is used in northeastern Brazilian folk medicine largely for the treatment of gynaecological and dermatological problems (1). Previous studies of this plant have shown antiulcerogenic (2), analgesic and anti-inflammatory (3, 4) effects. In clinical practice, there is anecdotal evidence that the use of A. urundeuva in topical preparations may cause, maintain or worsen cutaneous lesions, such as acute, subacute and chronic dermatitis. The present study deals with the preparation of extracts of A. urundeuva to be used in patch tests to determine prevalence of sensitivity and the dominant allergens involved with sensitization. It was accomplished in a transverse study of cases of contact dermatitis and sensitization to A. urundeuva in 137 patients attended at Dermatology Center of Walter Cantidio University Hospital/Federal University of Ceara, Brazil. The patients were submitted to patch test using hexane and ethanol extract of A. urundeuva and derived fractions. The plant was collected in Meruoca Hill, situated in Ceara State, and identified by Dr Afrânio Fernandes from the Prisco Bezerra Herbarium of Federal University of Ceara, where a voucher specimen is deposited under number 29851. The patch testing was preceded by anamnese and physical examination then applied using: Standard series (PATCHKIT STANDARD – FDA Allergenic), hexane and ethanol extracts in 2.5%, 5% and 10%; fractions of the hexane (Aur1, Aur2) and ethanol extracts (Aur3, Aur4) in 1% and 2% and cardol in 1% concentrations. All the samples and the constituents of the complementary series were diluted in ethyl alcohol (92.8 ) that was used as negative control. 3 of 137 (2%) patients showed 1 or more positive reactions to the hexane and ethanol extracts and fractions of A. urundeuva in the patch tests. Patient 1 had a positive test to 5% and 10% EtOH extract. He reported using topical preparation of A. urundeuva to treat a cutaneous rash, but instead of improvement, had accentuation of the lesions. Lesions resolved once treatment with the A. urundeuva preparation was stopped. Patient 2 showed positive results for the hexane extract, fraction Aur4 (2%) and cardol (1%). The patient also reported an improvement of the dermatitis, after suspension of topical use of A. urundeuva. Patient 3 had positive results with the fractions Aur3 (1%) and Aur4 (2%). Phytochemical tests (5) were performed with the fractions Aur1 and Aur2 which were classified as triterpenes; Aur3 showed to contain flavonoids and Aur4 contains pyrogallic tannins. In conclusion, ethanol soluble extractives and to a lesser extent hexane soluble extractives from the bark of A. urundeuva are capable of eliciting positive patch test reactions in persons who have apparently become sensitized to the plant material following its topical use.

Man, road and vehicle: risk factors associated with the severity of traffic accidents

OBJETIVO Analizar las caracteristicas de las victimas, vias y vehiculos involucrados en accidentes de transito y los factores de riesgo de accidentes con ocurrencia de obito. METODOS Estudio de cohorte no concurrente considerando los accidentes de transito en Fortaleza, CE, de enero de 2004 a diciembre de 2008. Se utilizaron datos del Sistema de Informaciones de Mortalidad, del Sistema de Informaciones Hospitalarias y de los bases de datos de Licencia para conducir y Vehiculos del Departamento Estatal de Transito. Tecnicas de relacionamiento deterministico y probabilistico se aplicaron para integrar las bases de datos. Se efectuo el analisis descriptivo de las variables relacionadas con las personas, las vias los vehiculos y el tiempo. Se utilizaron los modelos lineales generalizados en la investigacion de los factores de riesgo para obito por accidente de transito. El ajuste del modelo fue verificado por la tasa de vero-semejanza y el analisis ROC. RESULTADOS Se registraron 118.830 accidentes en el periodo. Predominaron colision/choque (78,1%), atropellamientos (11,9%), choque con obstaculo fijo (3,9%), con motocicletas (18,1%). Ocurrieron obitos en 1,4% de los accidentes. Estuvieron independientemente asociados al obito por accidente de transito: bicicletas (OR= 21,2; IC95% 16,1;27,8), atropellamientos (OR= 5,9; IC95% 3,7;9,2), choque con obstaculo fijo (OR= 5,7; IC95% 3,1;10,5) y accidentes con motociclistas (OR= 3,5; IC95% 2,6;4,6). Los principales factores contribuyentes fueron envolvimiento de una unica persona (OR= 6,6; IC95% 4,1;10,73), presencia de conductores sin licencia para conducir (OR= 4,1; IC95% 2,9;5,5), un unico vehiculo involucrado (OR= 3,9; IC95% 2,3;6,4), sexo masculino (OR= 2,5; IC95% 1,9; 3,3), transito en vias de jurisdiccion federal (OR= 2,4; IC95% 1,8;3,7), horario madrugada (OR= 2,4; IC95% 1,8;3,0), y dia domingo (OR= 1,7; IC95% 1,3;2,2), todas ajustadas de acuerdo con el modelo log-binomial. CONCLUSIONES Las acciones de promocion y prevencion de accidentes en el transito deben enfocarse en accidentes con vehiculos de dos ruedas, que mas frecuentemente involucran una unica persona, sin licencia para conducir, del sexo masculino, en horarios nocturnos, en fines de semana y en las vias donde se desarrollan mayores velocidades.OBJECTIVE To describe the main characteristics of victims, roads and vehicles involved in traffic accidents and the risk factors involved in accidents resulting in death. METHODS A non-concurrent cohort study of traffic accidents in Fortaleza, CE, Northeastern Brazil, in the period from January 2004 to December 2008. Data from the Fortaleza Traffic Accidents Information System, the Mortality Information System, the Hospital Information System and the State Traffic Department Driving Licenses and Vehicle database. Deterministic and probabilistic relationship techniques were used to integrate the databases. First, descriptive analysis of data relating to people, roads, vehicles and weather was carried out. In the investigation of risk factors for death by traffic accident, generalized linear models were used. The fit of the model was verified by likelihood ratio and ROC analysis. RESULTS There were 118,830 accidents recorded in the period. The most common types of accidents were crashes/collisions (78.1%), running over pedestrians (11.9%), colliding with a fixed obstacle (3.9%), and with motorcycles (18.1%). Deaths occurred in 1.4% of accidents. The factors that were independently associated with death by traffic accident in the final model were bicycles (OR = 21.2, 95%CI 16.1;27.8), running over pedestrians OR = 5.9 (95%CI 3.7;9.2), collision with a fixed obstacle (OR = 5.7, 95%CI 3.1;10.5) and accidents involving motorcyclists (OR = 3.5, 95%CI 2.6;4.6). The main contributing factors were a single person being involved (OR = 6.6, 95%CI 4.1;10.73), presence of unskilled drivers (OR = 4.1, 95%CI 2.9;5.5) a single vehicle (OR = 3.9, 95%CI 2,3;6,4), male (OR = 2.5, 95%CI 1.9;3.3), traffic on roads under federal jurisdiction (OR = 2.4, 95%CI 1.8;3.7), early morning hours (OR = 2.4, 95%CI 1.8;3.0), and Sundays (OR = 1.7, 95%CI 1.3;2.2), adjusted according to the log-binomial model. CONCLUSIONS Activities promoting the prevention of traffic accidents should primarily focus on accidents involving two-wheeled vehicles that most often involves a single person, unskilled, male, at nighttime, on weekends and on roads where they travel at higher speeds.