Juvenal Soares Dias da Costa

Prevalência de hipertensão arterial em adultos e fatores associados: um estudo de base populacional urbana em Pelotas, Rio Grande do Sul, Brasil

OBJECTIVE: To determine hypertension prevalence and its associated risk factors. METHODS: A cross-sectional, population-based study of people ages 20 to 69 living in the urban area of Pelotas, Rio Grande do Sul, Brazil, was conducted. The dependent variable systemic hypertension was defined as blood pressure >160 x 95 mm Hg (average of two readings) or current use of antihypertensive drugs. RESULTS: Among the 1,968 subjects enrolled in the study, hypertension prevalence was 23.6% (95% CI 21.6 to 25.3). A Poisson regression model was used to control confounding factors effects. The following variables remained statistically significant in the final model: family income, age, skin color, gender, family history of hypertension, extra salt intake, and body mass index. CONCLUSION: Compared with a similar study undertaken in 1992, hypertension prevalence increased, particularly in the younger groups.

Padrões alimentares de mulheres adultas residentes em área urbana no sul do Brasil

OBJETIVO: Explorar a existencia de padroes alimentares em mulheres adultas e fornecer dados para validacao do instrumento utilizado. METODOS: Estudo transversal de base populacional com amostra representativa de 1.026 mulheres adultas (20 a 60 anos de idade), residentes na regiao do Vale do Rio dos Sinos, Rio Grande do Sul, 2003. O instrumento utilizado para explorar os padroes alimentares foi o Questionario de Frequencia Alimentar, constituido de 70 itens. Para a identificacao dos padroes alimentares utilizou-se a analise fatorial de componentes principais. RESULTADOS: O indice de confianca da analise fatorial foi verificado por meio do determinante da matriz de correlacao (6,28-4), da medida de adequacao amostral (Kaiser-Meyer-Olkin=0,823) e do teste de esfericidade de Bartlett (chi²(1225)=7406,39; p<0,001), todos com resultados satisfatorios, garantindo o uso desta ferramenta. Foi possivel identificar cinco padroes alimentares, com 10 alimentos cada um, denominados de: padrao alimentar saudavel custo 1, padrao alimentar saudavel custo 2, padrao alimentar saudavel custo 3, padrao alimentar de risco custo 1 e padrao alimentar de risco custo 3. CONCLUSOES: Foi possivel identificar cinco padroes alimentares nas mulheres adultas estudadas, com diferencas de custos entre eles. Esses resultados sugerem que o custo pode ser um dos determinantes da escolha e consumo dos alimentos.

Características epidemiológicas, capacidade funcional e fatores associados em idosos de um plano de saúde

O presente estudo transversal objetivou tracar o perfil epidemiologico dos idosos associados a um plano de saude e verificar a capacidade funcional dos individuos, atraves do Indice de Barthel, e os fatores associados. A populacao deste estudo incluiu todos os associados do plano (titulares e seus respectivos dependentes), pertencentes a faixa etaria de 60 anos ou mais. Para a coleta de dados, foram utilizados dois questionarios: um socioeconomico familiar e outro individual de saude. Ambos os instrumentos foram autorrespondidos. Quanto a capacidade funcional entre 254 participantes idosos, quatro (1,6%) individuos apresentavam dependencia total, uma (0,4%) pessoa com dependencia grave, uma (0,4%) moderada, 29 (11,4%) leve e 219 (86,2%) foram classificados como independentes. Assim, a variavel foi agregada de forma que 86,2% foram classificados como independentes e 13,8% (IC95% 9,5 a 18,0) com dependencia. Na analise ajustada, apenas idade manteve-se associado ao desfecho. Os resultados mostraram que os individuos a partir dos 80 anos apresentaram maior probabilidade de incapacidade funcional. Apontou-se, tambem, que em populacoes com condicoes socioeconomicas mais elevadas existe a possibilidade de vies de sobrevivencia.

Case-control study on infant mortality in Southern Brazil

OBJECTIVE To identify risk factors associated with infant mortality and, more specifically, with neonatal mortality. METHODS A case-control study was carried out in the municipality of Caxias do Sul, Southern Brazil. Characteristics of prenatal care and causes of mortality were assessed for all live births in the 2001-2002 period with a completed live-birth certificate and whose mothers lived in the municipality. Cases were defined as all deaths within the first year of life. As controls, there were selected the two children born immediately after each case in the same hospital, who were of the same sex, and did not die within their first year of life. Multivariate analysis was performed using conditional logistic regression. RESULTS There was a reduction in infant mortality, the greatest reduction was observed in the post-neonatal period. The variables gestational age (<36 weeks), birth weight (<2,500 g), and 5-minute Apgar (<6) remained in the final model of the multivariate analysis, after adjustment. CONCLUSIONS Perinatal conditions comprise almost the totality of neonatal deaths, and the majority of deaths occur at delivery. The challenge for reducing infant mortality rate in the city is to reduce the mortality by perinatal conditions in the neonatal period.

Risk factors contributing to childhood poisoning

OBJECTIVE To investigate whether the lack of knowledge of toxic agents in households is a risk factor for individual unintentional childhood poisoning. METHODS The case group (n = 25) was composed of caregivers of children under 60 months of age who underwent accidental oral poisoning and were treated at two reference hospitals in Porto Alegre, southern Brazil, and recorded in the Toxicology Information Center database. The control group (n = 25) was composed of caregivers of children matched for sex, age, and presence in their homes of the same toxic agents found in the case group, who sought emergency medical care at the same hospitals, but for other reasons. A structured questionnaire was administered to verify the following questions: sociodemographic data, clinical history, behavioral antecedents of caregivers, storage of toxic agents, history of previous poisoning accidents. RESULTS The childrens mean age was 31.8 months (±0.97) and mean height was 93 cm (±11). Families, in both groups, were aware of the toxic action of agents available in their homes; however, caregivers in the control group were twice as likely to have such knowledge compared to the case group. Distraction was 15 times more likely to occur among caregivers of children who underwent poisoning compared to the control group. Storage of toxic agents below 150 cm was approximately 17 times more likely to occur in the group of children who underwent poisoning compared to children in the control group. CONCLUSIONS Lack of knowledge of the toxic action of agents stored in households is not a risk factor for childhood poisoning. The attributable risks described in this study indicated that the elimination of other factors, such as distraction and storage below 150 cm, would lead to the prevention of 13 and 19% of poisonings in childhood, respectively.

Fatores de risco que contribuem para o envenenamento pediátrico

OBJECTIVE: To investigate whether the lack of knowledge of toxic agents in households is a risk factor for individual unintentional childhood poisoning. METHODS: The case group (n = 25) was composed of caregivers of children under 60 months of age who underwent accidental oral poisoning and were treated at two reference hospitals in Porto Alegre, southern Brazil, and recorded in the Toxicology Information Center database. The control group (n = 25) was composed of caregivers of children matched for sex, age, and presence in their homes of the same toxic agents found in the case group, who sought emergency medical care at the same hospitals, but for other reasons. A structured questionnaire was administered to verify the following questions: sociodemographic data, clinical history, behavioral antecedents of caregivers, storage of toxic agents, history of previous poisoning accidents. RESULTS: The childrens mean age was 31.8 months (±0.97) and mean height was 93 cm (±11). Families, in both groups, were aware of the toxic action of agents available in their homes; however, caregivers in the control group were twice as likely to have such knowledge compared to the case group. Distraction was 15 times more likely to occur among caregivers of children who underwent poisoning compared to the control group. Storage of toxic agents below 150 cm was approximately 17 times more likely to occur in the group of children who underwent poisoning compared to children in the control group. CONCLUSIONS: Lack of knowledge of the toxic action of agents stored in households is not a risk factor for childhood poisoning. The attributable risks described in this study indicated that the elimination of other factors, such as distraction and storage below 150 cm, would lead to the prevention of 13 and 19% of poisonings in childhood, respectively.

Internações por condições sensíveis à atenção primária nas coordenadorias de saúde no RS

OBJECTIVE To compare rates of hospitalization for primary care-sensitive conditions in the major municipalities of regional health districts. METHODS An ecological study was carried out with both male and female subjects aged 20 to 59 years in the major municipalities of regional health districts in the state of Rio Grande do Sul, Southern Brazil, between 1995 and 2007. Hospitalization data were obtained from the database of the Brazilian Health Care System (Datasus). Rates by Poisson regression with robust variance were analyzed. Rates for each municipality were compared to those of the remainder of the Rio Grande do Sul state excluding the major municipalities of each district. RESULTS There was a reduction in the rates of hospitalization for primary care-sensitive conditions in all municipalities, with the exception of Porto Alegre (1.01) and Osório (1.02). Among larger municipalities, the greatest reductions were observed in Santa Maria (0.92) and Pelotas (0.93). Rates in medium-sized municipalities showed a decrease towards the end of the study period. Among small municipalities, only Lajeado and Frederico Westphalen showed rates lower than those of the rest of the state in 2007. The highest rates were found in the smallest municipalities. CONCLUSIONS There was a trend towards a reduction in hospitalizations in almost all municipalities, possibly due to the expansion of primary health care that took place even prior to the implementation of the Family Health Program and changes in management. The high rates of hospitalization in small municipalities suggest that hospitalization for primary care-sensitive conditions may be a means of justifying an idle supply of hospital beds.OBJETIVO: Comparar taxas de internacoes por condicoes sensiveis em municipios-sede de coordenadorias de saude. METODOS: Estudo ecologico com individuos de ambos os sexos de 20 a 59 anos nos municipios-sede das coordenadorias regionais de saude do Rio Grande do Sul de 1995 a 2007. Os dados sobre internacoes foram obtidos do Datasus. Foram analisadas as taxas mediante regressao de Poisson com variacao robusta. As taxas dos municipios foram comparadas com as do restante do estado do Rio Grande do Sul, excluidos os municipios-sede. RESULTADOS: Os municipios, exceto Porto Alegre (1,01) e Osorio (1,02), apresentaram reducao das taxas de internacoes por condicoes sensiveis. Entre os municipios grandes, as maiores quedas foram observadas em Santa Maria (0,92) e Pelotas (0,93). Os municipios medios apresentaram taxas inferiores no final do periodo. Nos pequenos, apenas Lajeado e Frederico Westphalen apresentaram taxas inferiores as do estado em 2007. As maiores taxas foram observadas nos municipios pequenos. CONCLUSOES: Houve tendencia de diminuicao das internacoes em quase todos os municipios, possivelmente pela ampliacao da atencao primaria antes mesmo do Programa Saude da Familia e das modificacoes de gestao. As elevadas taxas de hospitalizacoes em municipios pequenos sugerem ocupacao de leitos por condicoes sensiveis para justificar oferta ociosa.

Prevalência de internação hospitalar e fatores associados em Pelotas, RS

OBJECTIVE To estimate the prevalence of hospitalizations and to identify characteristics associated with hospital admission. METHODS We carried out a population-based cross-sectional study of subjects of both sexes, aged 20-69 years, and who lived in the urban area of Pelotas, Southern Brazil, between 1999 and 2000. Subjects were interviewed using a standardized, pre-coded questionnaire. Analysis was stratified by sex and confounder control was carried out using Poisson regression. Variables analyzed included socioeconomic and demographic characteristics, lifestyle, morbidities, and medical appointments in the last year. RESULTS Of the 1,916 subjects interviewed, 146 (7.6%; 95%CI: 6.4;8.8) had been hospitalized in the year preceding the interview. Among men, characteristics associated with hospitalization included age above 50 years, schooling between five and seven years, history of smoking, minor psychiatric disorders, and medical appointments in the last year. For women, hospitalization was more frequent among subjects aged 60-69 years, with five to seven years of schooling, and who had had medical appointments within the last year. Women who consumed under 30 g/day of alcohol were less likely to have been hospitalized. Prevalence of hospitalization for primary care-sensitive causes was 13.0% (95%CI: 7.6;18.5). CONCLUSIONS Prevalence of hospitalization is similar in men and women. Schooling, but not income, was found to be associated with hospitalization.OBJETIVO: Estimar a prevalencia de hospitalizacoes e identificar caracteristicas associadas a internacao hospitalar. METODOS: Estudo transversal de base populacional realizado com individuos de ambos os sexos, de 20 a 69 anos, residentes na zona urbana de Pelotas, RS, entre 1999 e 2000. Foi utilizado questionario padronizado e pre-codificado. Foi realizada analise estratificada entre os sexos e controle de fatores de confusao por meio de Regressao de Poisson. Foram incluidas na analise variaveis socioeconomicas, demograficas, habitos de vida, morbidades e consulta com medico no ultimo ano. RESULTADOS: Dos 1.916 individuos, 146 (7,6%, IC95%:6,4;8,8) haviam sido hospitalizados no ultimo ano desde a entrevista. Entre os homens, as caracteristicas que se mostraram associadas a internacao foram: idade de 50 anos ou mais, entre cinco e sete anos de escolaridade, ex-fumantes, disturbios psiquiatricos menores e consulta com medico no ultimo ano. Entre as mulheres com idade entre 60 e 69 anos, entre cinco e sete anos de escolaridade e consulta medica no periodo de um ano antes da entrevista, ocorreram maiores prevalencias de hospitalizacao. As mulheres que consumiam menos de 30 g/dia de alcool mostraram menor frequencia de hospitalizacao. A prevalencia de internacao por causas sensiveis a atencao primaria foi de 13,0% (IC 95%: 7,6;18,5). CONCLUSOES: Homens e mulheres apresentaram prevalencias semelhantes de internacao hospitalar. Foi encontrada associacao entre escolaridade e internacao, mas nao entre renda e internacao.

Temporal evolution and spatial distribution of maternal death

OBJECTIVE To analyze the temporal evolution of maternal mortality and its spatial distribution. METHODS Ecological study with a sample made up of 845 maternal deaths in women between 10 and 49 years, registered from 1999 to 2008 in the state of Rio Grande do Sul, Southern Brazil. Data were obtained from Information System on Mortality of Ministry of Health. The maternal mortality ratio and the specific maternal mortality ratio were calculated from records, and analyzed by the Poisson regression model. In the spatial distribution, three maps of the state were built with the rates in the geographical macro-regions, in 1999, 2003, and 2008. RESULTS There was an increase of 2.0% in the period of ten years (95%CI 1.00;1.04; p = 0.01), with no significant change in the magnitude of the maternal mortality ratio. The Serra macro-region presented the highest maternal mortality ratio (1.15, 95%CI 1.08;1.21; p < 0.001). Most deaths in Rio Grande do Sul were of white women over 40 years, with a lower level of education. The time of delivery/abortion and postpartum are times of increased maternal risk, with a greater negative impact of direct causes such as hypertension and bleeding. CONCLUSIONS The lack of improvement in maternal mortality ratio indicates that public policies had no impact on women’s reproductive and maternal health. It is needed to qualify the attention to women’s health, especially in the prenatal period, seeking to identify and prevent risk factors, as a strategy of reducing maternal death.

Assistência à criança: preenchimento da caderneta de saúde em municípios do semiárido brasileiro

Objectives: to determine the proportion of children with adequately completed health records and to investigate associations with geographical, socioeconomic and the mother and childs biological characteristics, and with the percentage use of health services in two municipalities in the semi-arid region of Brazil. Methods: a population-based cross-sectional study was carried with children aged up to five years. Data were collected by way of a household questionnaire between July and September 2008. The presence of all records relating to identification, growth, development and vaccine status of the child was deemed to be adequate completion. The raw and adjusted prevalence ratios were calculated using the Poisson Regression, following a hierarchized model. Results: of the 342 children studied, 22.2% (CI95% 17.5 - 26.2) had adequately completed health records. A high level of education of the mother was associated with this, after adjusting for the effect of variables in the hierarchized model. Conclusions: the results show a low level of adequate completion of health records. The high prevalence of inadequately completed records in mothers with low levels of education may reflect inequalities in the local health system. Children have a right to adequate completion of health records and failure to do so suggests lack of training of health workers and parents in basic health care needs.