Juliana Feliciati Hoffmann

Prevalência de diabetes e hipertensão no Brasil baseada em inquérito de morbidade auto-referida, Brasil, 2006

OBJETIVO: Estimar la prevalencia de diabetes y de hipertension auto-referidas y sus numeros absolutos en Brasil. METODOS: Fueron analizados datos referentes a los 54.369 individuos con edad >18 anos entrevistados por el Sistema de Vigilancia de Factores de Riesgo y Proteccion para Enfermedades Cronicas por Pesquisa Telefonica (VIGITEL), realizado en las 27 capitales brasileras en 2006, que respondieron positivamente a preguntas sobre presion alta y diabetes. Los porcentajes de hipertension y diabetes auto-referidas estimados en la muestra fueron proyectados para la poblacion brasilera segun edad, sexo y estado nutricional, utilizando el metodo directo de estandarizacion. RESULTADOS: La prevalencia de diabetes fue de 5,3%, mayor entre las mujeres (6,0% vs. 4,4%), variando de 2,9% en Palmas (Norte de Brasil) a 6,2% en Sao Paulo (Sureste). La prevalencia de hipertension fue de 21,6% (21,3;22,0), mayor entre las mujeres (24,4% vs. 18,4%), variando de 15,1% en Palmas a 24,9% en Recife (Noreste). Las prevalencias aumentaron con categorias de edad y nutricion. Se estimo haber en Brasil un total de 6.317.621 de adultos que refieren tener diabetes y 25.690.145 de adultos que refieren tener hipertension. CONCLUSIONES: Las prevalencias de diabetes e hipertension auto-referidas son elevadas en Brasil. El monitoreo de estas y otras condiciones de salud puede ser realizado por estrategias como la del VIGITEL, preferiblemente acompanado de estudios de validez, visando la generalizacion de los resultados.OBJECTIVE To estimate the prevalence of self-reported diabetes and hypertension and their absolute numbers in Brazil. METHODS Data from 54,369 individuals aged > or = 18 years, interviewed by the Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL--Telephone-based Surveillance of Risk and Protective Factors for Chronic Diseases), conducted in 27 Brazilian state capitals in 2006, and who responded positively to questions about high blood pressure and diabetes, were analyzed. Percentages of self-reported hypertension and diabetes, estimated in the sample, were projected to the Brazilian population, according to age, sex and nutritional status, using the direct standardization method. RESULTS Prevalence of diabetes was 5.3% higher in women (6.0% vs. 4.4%), varying from 2.9% in Palmas (Northern Brazil) to 6.2% in São Paulo ( Southeastern Brazil). Prevalence of hypertension was 21.6% (21.3; 22.0) higher in women (24.4% vs. 18.4%), varying from 15.1% in Palmas to 24.9% in Recife (Northeastern Brazil). Prevalences increased with age and nutritional status. It was estimated that there were 6,317,621 adults who reported having diabetes and 25,690,145 adults who reported having hypertension in Brazil. CONCLUSIONS Prevalence of self-reported diabetes and hypertension are high in Brazil. Monitoring of these and other health conditions can be performed using strategies such as the VIGITEL, especially if followed by validation studies, aiming to generalize results.

Health-related quality of life in Brazil: normative data for the SF-36 in a general population sample in the south of the country

The objective of this study was to provide normative SF-36 scores in a general population sample in Brazil and to describe differences in mean scores according to socio-demographic characteristics. The SF-36 questionnaire was distributed to a randomly selected sample of the general population of Porto Alegre in the State of Rio Grande do Sul. The response rate was 68% and 755 subjects were included (38% male, 62% female). Lower health status was revealed among females in the 30 to 44 year age bracket, from the lower income class, with less education and self-reported chronic medical conditions. The results and percentiles of scores of the SF-36 are reported as normative data for the general population. The SF-36 was an acceptable and practical instrument for measuring health-related quality of life in a sample of Brazilians. The results of this study can be useful for researchers using the SF-36 questionnaire in other groups to compare the scores with normative data. The SF-36 may prove a valuable tool for discovering vulnerable groups in epidemiological studies due to the ability to discriminate between different population subgroups.

Prevalence of diabetes and hypertension based on self- reported morbidity survey, Brazil, 2006

OBJETIVO: Estimar la prevalencia de diabetes y de hipertension auto-referidas y sus numeros absolutos en Brasil. METODOS: Fueron analizados datos referentes a los 54.369 individuos con edad >18 anos entrevistados por el Sistema de Vigilancia de Factores de Riesgo y Proteccion para Enfermedades Cronicas por Pesquisa Telefonica (VIGITEL), realizado en las 27 capitales brasileras en 2006, que respondieron positivamente a preguntas sobre presion alta y diabetes. Los porcentajes de hipertension y diabetes auto-referidas estimados en la muestra fueron proyectados para la poblacion brasilera segun edad, sexo y estado nutricional, utilizando el metodo directo de estandarizacion. RESULTADOS: La prevalencia de diabetes fue de 5,3%, mayor entre las mujeres (6,0% vs. 4,4%), variando de 2,9% en Palmas (Norte de Brasil) a 6,2% en Sao Paulo (Sureste). La prevalencia de hipertension fue de 21,6% (21,3;22,0), mayor entre las mujeres (24,4% vs. 18,4%), variando de 15,1% en Palmas a 24,9% en Recife (Noreste). Las prevalencias aumentaron con categorias de edad y nutricion. Se estimo haber en Brasil un total de 6.317.621 de adultos que refieren tener diabetes y 25.690.145 de adultos que refieren tener hipertension. CONCLUSIONES: Las prevalencias de diabetes e hipertension auto-referidas son elevadas en Brasil. El monitoreo de estas y otras condiciones de salud puede ser realizado por estrategias como la del VIGITEL, preferiblemente acompanado de estudios de validez, visando la generalizacion de los resultados.OBJECTIVE To estimate the prevalence of self-reported diabetes and hypertension and their absolute numbers in Brazil. METHODS Data from 54,369 individuals aged > or = 18 years, interviewed by the Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL--Telephone-based Surveillance of Risk and Protective Factors for Chronic Diseases), conducted in 27 Brazilian state capitals in 2006, and who responded positively to questions about high blood pressure and diabetes, were analyzed. Percentages of self-reported hypertension and diabetes, estimated in the sample, were projected to the Brazilian population, according to age, sex and nutritional status, using the direct standardization method. RESULTS Prevalence of diabetes was 5.3% higher in women (6.0% vs. 4.4%), varying from 2.9% in Palmas (Northern Brazil) to 6.2% in São Paulo ( Southeastern Brazil). Prevalence of hypertension was 21.6% (21.3; 22.0) higher in women (24.4% vs. 18.4%), varying from 15.1% in Palmas to 24.9% in Recife (Northeastern Brazil). Prevalences increased with age and nutritional status. It was estimated that there were 6,317,621 adults who reported having diabetes and 25,690,145 adults who reported having hypertension in Brazil. CONCLUSIONS Prevalence of self-reported diabetes and hypertension are high in Brazil. Monitoring of these and other health conditions can be performed using strategies such as the VIGITEL, especially if followed by validation studies, aiming to generalize results.

Estimating the SF-6D Value Set for a Population-Based Sample of Brazilians

OBJECTIVES SF-6D is a preference-based measure of health developed to estimate utility values from the SF-36. The aim of this study was to estimate a weighting system for the SF-6D health states representing the preferences of a sample of the Southern Brazilian general population. METHODS A sample of 248 health states defined by the SF-6D was valued by a sample of the southern Brazilian population using the standard gamble. Mean and individual level multivariate regression models were fitted to the standard gamble valuation data to estimate preference weights for all SF-6D health states. The models were compared with those estimated in the UK study. RESULTS Five hundred twenty-eight participants were interviewed, but 58 (11%) were excluded for failing to value the worst state. Data from 469 subjects producing 2696 health states valuations were used in the regression analysis. In contrast to the best performing model for the UK data, the best performing model for the Brazilian data was a random effects model using only the main effects variables, highlighting the importance of adopting a country-specific algorithm to derive SF-6D health states values. Inconsistent coefficients were merged to produce the final recommended model, which has all significant coefficients and a mean absolute difference between observed and predicted standard gamble values of 0.07. CONCLUSIONS The results provide the first population-based value set for Brazil for SF-6D health states, making it possible to generate quality-adjusted life years for cost-utility studies using regional data. Besides, utility weights derived using the preferences of a sample from a southern Brazilian population can be derived from existing SF-36 data sets.

Nutrition, mental health and violence: from pregnancy to postpartum Cohort of women attending primary care units in Southern Brazil - ECCAGE study

BackgroundWomans nutritional status, before and during pregnancy, is a strong determinant of health outcomes in the mother and newborn. Gestational weight gain and postpartum weight retention increases risk of overweight or obesity in the future and they depend on the pregestational nutritional status and on food consumption and eating behavior during pregnancy. Eating behavior during pregnancy may be the cause or consequence of mood changes during pregnancy, especially depression, which increases likelihood of postpartum depression. In Brazil, a study carried out in the immediate postpartum period found that one in three women experienced some type of violence during pregnancy. Violence and depression are strongly associated and both exposures during pregnancy are associated with increased maternal stress and subsequent harm to the infant. The main objectives of this study are: to identify food intake and eating behaviors patterns; to estimate the prevalence of common mental disorders and the experience of violence during and after pregnancy; and to estimate the association between these exposures and infants health and development.Methods/DesignThis is a cohort study of 780 pregnant women receiving care in 18 primary care units in two cities in Southern Brazil. Pregnant women were first evaluated between the 16th and 36th week of pregnancy at a prenatal visit. Follow-up included immediate postpartum assessment and around the fifth month postpartum. Information was obtained on sociodemographic characteristics, living circumstances, food intake, eating behaviors, mental health and exposure to violence, and on infants development and anthropometrics measurements.DiscussionThis project will bring relevant information for a better understanding of the relationship between exposures during pregnancy and how they might affect child development, which can be useful for a better planning of health actions aiming to enhance available resources in primary health care.

Eating disorders symptoms in pregnancy and postpartum: A prospective study in a disadvantaged population in Brazil

OBJECTIVE To assess eating disorder symptoms (EDS) from prepregancy through postpartum. METHOD Seven hundred and twelve women with gestational age ranging from 16th to 36th week completed the eating disorder examination questionnaire (EDE-Q). A shortened version of the EDE-Q was used to assess, retrospectively, EDS during the last 28 days of the pregestational period. Follow up assessment occurred at the 4th-5th month postpartum (n = 427). Generalized structural equation models were used to estimate risk of EDS in pregestation, gestation, and postpartum. RESULTS Women who did not participate in follow up (n = 285) were not significantly different in sociodemographic characteristics. In postpartum, a higher number of women referred shape (RR = 1.65; 95% CI 1.19-2.30) and weight concerns (RR = 1.64; 95% CI 1.16-2.31) than in pregestation. Binge eating (BE) and self-induced vomiting diminished during pregnancy (RR = 0.70, 95% CI 0.57-0.85; RR = 0.21, 95% CI 0.10-0.44, respectively) and postpartum (RR = 0.62, 95% CI 0.48-0.80; RR = 0.38, 95% CI 0.19-0.76, respectively) compared with pregestation DISCUSSION Shape and weight concerns are highly prevalent in postpartum and may confer risk for the development of inappropriate eating behaviors. Health professionals should be trained on how to recognize these symptoms.

Association between dietary patterns and mental disorders in pregnant women in Southern Brazil

Objective: To evaluate the association between dietary patterns and mental disorders among pregnant women in southern Brazil. Methods: Cross-sectional study with 712 pregnant women recruited from the Study of Food Intake and Eating Behaviors in Pregnancy (ECCAGe). Food intake assessment was performed using the Food Frequency Questionnaire. Dietary patterns were identified by cluster analysis. The Primary Care Evaluation of Mental Disorders (PRIME-MD) was used to evaluate participants’ mental health. Poisson regression models with robust variance were fitted to estimate prevalence ratios (PR). Results: In the adjusted models, there was a high prevalence of major depressive disorder among women with low fruit intake (43%, PR 1.43, 95%CI 1.04-1.95) and high sweets and sugars intake (91%, PR 1.91, 95%CI 1.19-3.07). Women with a common-Brazilian dietary pattern had higher prevalence of major depressive disorder compared to those with a varied consumption pattern (PR 1.43, 95%CI 1.01-2.02). Low intake of beans was significantly associated with generalized anxiety disorder (PR 1.40, 95%CI 1.01-1.93). Conclusions: Low consumption of fruits and beans and intake of the common-Brazilian dietary pattern during pregnancy were associated with higher prevalence of mental disorders. These results reinforce the importance of an adequate dietary intake to ensure better mental health in pregnancy.

TRANSFERÊNCIA DE POLÍTICA: PERSPECTIVA DO TRATAMENTO DIRETAMENTE OBSERVADO DA TUBERCULOSE

Objective: to investigate how the policy transfer of the Directly Observed Treatment of Tuberculosis was developed from the perspective of the community health professionals of the Conceicao Hospital Group. Method: it is a quantitative research of the epidemiological inquiry type, which was based on the application of a validated and self-directed instrument to the health professionals belonging to the 12 Primary Health Care Units to the Community Health Service of the Conceicao Hospital Group. For the analysis, the beta regression, the description of the frequencies of the variables, the distribution of the mean, median and the standard deviation were used. In addition, the standardized mean and standardized scores were created. Results: 109 health professionals participated in the study, most of them female (77.06%), aged between 30 and 59 years old (87.16%) and belonging to the medical category (37.61%). Regarding the three analyzed dimensions of the policy transfer process, it was observed that the Knowledge dimension was the one that had the highest score (77.8%), followed by the dimensions Information (72.7%) and Innovation (67.7%). The need for involvement and participation of the population in the discussions of Directly Observed Treatment, improvement of the infrastructure of the health services and the complexity of the process of accomplishment of this practice were some, among others, important aspects pointed out. Conclusion: it is necessary to reformulate and improve the actions related to the operationalization and transfer of the Directly Observed Treatment of Tuberculosis

Planning pathways in the transfer of Directly Observed Treatment of Tuberculosis

1 Artículo parte de tesis de doctorado “The planning and transfer of the Directly Observed Treatment of Tuberculosis policy in the municipality of Porto Alegre RS”, presentada en la Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Centro Colaborador de la OPS/OMS para el Desarrollo de la Investigación en Enfermería, Ribeirão Preto, SP, Brasil. Apoyo financiero del Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brasil. 2 Estudiante de postdoctorado, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Centro Colaborador de la OPS/OMS para el Desarrollo de la Investigación en Enfermería, Ribeirão Preto, SP, Brasil. Enfermera, Departamento de Ações em Saúde, Secretaria Estadual de Saúde do Rio Grande do Sul, Porto Alegre, RS, Brasil. 3 PhD, Profesor Doctor, Escola de Medicina, Universidade de Lúrio, Marrere, Nampula, Mozambique. 4 Estudiante de doctorado, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil. Estadística, Departamento de Planejamento Governamental, Secretaria de Planejamento, Governança e Gestão do Rio Grande do Sul, Porto Alegre, RS, Brasil. 5 Estudiante de doctorado, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil. Enfermera, Unidade de Terapia Intensiva Neonatal, Fundação Maternidade Sinhá Junqueira, Ribeirão Preto, SP, Brasil. 6 PhD, Profesor Asociado, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Centro Colaborador de la OPS/OMS para el Desarrollo de la Investigación en Enfermería, Ribeirão Preto, SP, Brasil. Vías de la planificación en la transferencia del Tratamiento Directamente Observado de la tuberculosis1ABSTRACT Objective: to investigate the planning pathways in the transfer of Directly Observed Treatment of tuberculosis. Method: a qualitative study conducted using interviews and a semi-structured guide, administered to five subjects who were among the coordinators and managers of the tuberculosis control programs, and the secretary of health of a municipality in the south of Brazil. Situational Strategic Planning and Discourse Analysis of the French matrix were the theoretical and analytical references used, respectively. Results: three reflexive axes were identified: weaknesses in the process of planning the Directly Observed Treatment transfer, antagonism between planning and daily requirements and formulation of planning and execution. Lack of systematization regarding the planning and execution for transfer the Directly Observed Treatment policy, demonstrates the fragility and incipience of this activity, and the possibility of its non-existence. Conclusion: the urgent need for managers and coordinators to better appropriate the theoretical framework for changing public policies, and the related planning mechanisms, includes a proposal for reorganization and qualification of the diffusion process, both practical-operative and political-organization.

Directly Observed Treatment: planning perspectives, improvisation and transfer of policy

OBJECTIVE to investigate the possibilities of positive and negative association of improvisation and the understanding of what will be the planning by managers and coordinators of tuberculosis control programs, in a context of transference of the Directly Observed Treatment policy. METHOD this is a qualitative study, developed through semi-structured interviews analyzed in the light of French Discourse Analysis. RESULTS there was a weakening of the constructive and operational planning process, which is at the mercy of political will and the need of putting out fires. This, in turn, along with achômetro (Brazilian popular expression used on unsubstantiated point of view or opinion that is based solely and exclusively on the intuition of the person who says it), composed the metaphor of improvisation in its negative perspective, understood by automatism and unsystematization process. Improvisation, however, emerged as a representation of innovation, creativity, and contextual change. FINAL CONSIDERATIONS both the planning and the transfer of public policies constitute processes that need to be strengthened and qualified in the field of public health.