Leila Posenato Garcia

Evolução da prevalência do diabetes e deste associado à hipertensão arterial no Brasil: análise da Pesquisa Nacional por Amostra de Domicílios, 1998, 2003 e 2008

Objective: to estimate the prevalence of diabetes, and associated hypertension for Brazilian states and Federal District, in 2008, and describe its temporal trends according to sociodemographic variables and its distribution in Brazil and regions, in 1998, 2003 and 2008. Methods: cross-sectional study with microdata from the National Household Sample Survey in the selected years; crude and age-and-sex standardized prevalence rates were calculated for the entire population and for subgroups of the sociodemographic variables. Results: in Brazil, the standardized prevalence rate of diabetes increased from 2.9% in 1998 to 4.3% in 2008; for diabetes associated to hypertension, this ratio rose from 1.7% to 2.8% over the same period. These increases were statistically significant for Brazil, as well as for all rates and categories of the studied variables. Conclusion: the prevalence of diabetes and associated hypertersion is growing rapidly in Brazil.

Evolução das desigualdades socioeconômicas na mortalidade infantil no Brasil, 1993-2008

In Brazil, infant and child mortality reveal a downward trend. Few studies have investigated the temporal trends in the inequalities of these deaths, at individual level, according to socio-economic status. The scope of this article was to investigate the temporal trends of the magnitude of inequalities in infant and child mortality, between groups defined by maternal education and household income per capita in the 1993-2008 period in Brazil. Microdata from the National Household Sample Survey were used. The inequality measure was the concentration index (CI). It was calculated for infant and child deaths, according to maternal education and household income per capita. During the 2003-2008 period, there was a reduction in inequalities in infant and child mortality, at individual level, and according to maternal education and household income per capita. In 2008, the concentration of child deaths among children whose mothers had less education was higher than the concentration of infant deaths. The CI according to income had greater variability, but also demonstrated a lower concentration of deaths at the end of the period. The measurement of inequalities in health is important for monitoring the population health situation.No Brasil, a mortalidade infantil e na infância apresentam tendencia decrescente. Poucos estudos investigaram a evolucao temporal das desigualdades socioeconomicas nesses obitos, no nivel individual. O objetivo foi investigar a evolucao temporal da magnitude das desigualdades na mortalidade infantil e na infância, segundo a escolaridade materna e a renda domiciliar per capita, no periodo 1993-2008, no Brasil. Foram utilizados microdados das Pesquisas Nacionais por Amostra de Domicilios (PNAD). A medida de desigualdade empregada foi o indice de concentracao (IC), calculado para os obitos infantis e na infância, segundo escolaridade materna e renda domiciliar per capita. No periodo de 1993 a 2008, houve reducao das desigualdades na mortalidade infantil e na infância, no nivel individual, segundo a escolaridade materna e a renda domiciliar per capita. Em 2008, a concentracao dos obitos na infância entre criancas cujas maes tinham menor escolaridade era maior do que a concentracao dos obitos infantis. Os IC segundo a renda apresentaram maior variabilidade, mas tambem demonstraram menor concentracao dos obitos ao final do periodo. A medicao das desigualdades em saude e importante para o acompanhamento da situacao de saude da populacao.

Associação ecológica entre características dos municípios e o risco de homicídios em homens adultos de 20-39 anos de idade no Brasil, 1999-2010

Homicide mortality remains a major public health problem in Brazil, especially among young adult males. The aim of this study was to assess the homicide mortality risk (HMR) among males aged 20 to 39, and its association with selected socio-demographic characteristics of the Brazilian municipalities. This is an ecologic study in which all the municipalities in Brazil were the unit of analysis. Time trends (from 1999-2002) and adjusted associations between HMR and socio-demographic characteristics of municipalities were estimated in a cross-sectional analysis for 2007-2010 in this study. Between 1999-2002 and 2007-2010, an increasing trend of mean HMR rates from 22.7 to 35.5 per 100,000 inhabitants was observed in Brazil. In 2007-2010, HMR rates were significantly higher (p<0.001) in the largest cities, with higher fertility rates, lower literacy rates, higher social inequality (as estimated by the 20/40 income ratio) and more-urbanized municipalities. Considering the proportion of low income population and the average per capita income, associations with HMR identified greater risks in the intermediary categories of these independent variables. Findings from this study may support the implementation of focal policies directed to more vulnerable municipalities.

Avaliação preliminar do impacto da Lei da Cadeirinha sobre os óbitos por acidentes de automóveis em menores de dez anos de idade, no Brasil: estudo de séries temporais no período de 2005 a 2011

Objective: to evaluate the preliminary impact of a child restraint law on the occurrence of deaths caused by car accidents among under ten years old, in Brazil. Methods: a time series study with before and after design data from the Mortality Information System during the period from September 2005 to August 2011; the Seasonal Auto-Regressive Integrated Moving Average (SARIMA) model was used. Results: within one year after the enactment of the law, 227 deaths were recorded, while in the previous year, 296 were recorded; the annual average for the previous five years was 267.8; after the enactment of the law, there was a 23.0% negative variation in the absolute number of deaths,with no statistical significance. Conclusion: despite the reduction in the absolute number of deaths, a statistically significant impact of the law was not observed, possibly due to the short post-intervention observation period.

Óbitos registrados com causa básica hanseníase no Brasil: uso do relacionamento de bases de dados para melhoria da informação

This study sought to describe the characteristics of deaths with leprosy as the underlying cause recorded in the Mortality Information System (SIM) and compare these characteristics with the groups of cases where the cause of death was reported, or failed to be reported, in the National Case Registration Database (Sinan). Deaths with leprosy as the underlying cause occurring in Brazil in the 2004-2009 period, and cases of leprosy from 1975 to 2010 were included. The probabilistic bases of SIM and Sinan were compared. Of the 1,463 deaths from leprosy recorded in SIM, 44.2% were not recorded in Sinan. Of the total number of deaths, the majority were men (72.5%), aged 60 or older (56.6%), occurring in hospitals (65.3%) and with due care (45.8%). Of the 820 deaths identified in Sinan, 92% were patients with multibacillary disease, 45.2% were discharged as cured by Sinan and 38.9% died. Deaths due to leprosy were found on SIM that were not notified to Sinan. The data base linkage enabled identification of ancillary records and inconsistencies between the systems.This study sought to describe the characteristics of deaths with leprosy as the underlying cause recorded in the Mortality Information System (SIM) and compare these characteristics with the groups of cases where the cause of death was reported, or failed to be reported, in the National Case Registration Database (Sinan). Deaths with leprosy as the underlying cause occurring in Brazil in the 2004-2009 period, and cases of leprosy from 1975 to 2010 were included. The probabilistic bases of SIM and Sinan were compared. Of the 1,463 deaths from leprosy recorded in SIM, 44.2% were not recorded in Sinan. Of the total number of deaths, the majority were men (72.5%), aged 60 or older (56.6%), occurring in hospitals (65.3%) and with due care (45.8%). Of the 820 deaths identified in Sinan, 92% were patients with multibacillary disease, 45.2% were discharged as cured by Sinan and 38.9% died. Deaths due to leprosy were found on SIM that were not notified to Sinan. The data base linkage enabled identification of ancillary records and inconsistencies between the systems.

Investigação epidemiológica dos óbitos notificados tendo como causa básica a hanseníase, ocorridos em Fortaleza, Ceará, 2006-2011

OBJETIVO:descrever as caracteristicas e os resultados da investigacao dos obitos registrados tendo como causa basica a hanseniase, ocorridos em hospitais selecionados do municipio de Fortaleza-CE, Brasil.METODOS:estudo descritivo, do tipo de serie de casos, em que foram investigados obitos registrados no Sistema de Informacoes sobre Mortalidade (SIM) no periodo 2006-2011; a investigacao foi conduzida por equipe multidisciplinar treinada, utilizando instrumento padronizado, e consulta a prontuarios hospitalares e ambulatoriais.RESULTADOS:dos 19 obitos investigados, confirmou-se que 11 ocorreram por complicacoes da hanseniase, e destes, a maioria foi de homens (n=9) e individuos de cor da pele ou raca preta/parda (n=10); entre os obitos confirmados por hanseniase, o motivo da internacao mais frequente foi reacao hansenica (n=7).CONCLUSAO:a investigacao confirmou a ocorrencia de obitos causados por complicacoes da hanseniase, assim como a existencia de obitos por outras causas embora registrados como sendo por hanseniase.

Outcomes of Zika virus infection during pregnancy: contributions to the debate on the efficiency of cohort studies

BackgroundZika infection during pregnancy (ZIKVP) is known to be associated with adverse outcomes. Studies on this matter involve both rare outcomes and rare exposures and methodological choices are not straightforward. Cohort studies will surely offer more robust evidences, but their efficiency must be enhanced. We aim to contribute to the debate on sample selection strategies in cohort studies to assess outcomes associated with ZKVP.Main body of the abstractA study can be statistically more efficient than another if its estimates are more accurate (precise and valid), even if the studies involve the same number of subjects. Sample size and specific design strategies can enhance or impair the statistical efficiency of a study, depending on how the subjects are distributed in subgroups pertinent to the analysis. In most ZIKVP cohort studies to date there is an a priori identification of the source population (pregnant women, regardless of their exposure status) which is then sampled or included in its entirety (census). Subsequently, the group of pregnant women is classified according to exposure (presence or absence of ZIKVP), respecting the exposed:unexposed ratio in the source population. We propose that the sample selection be done from the a priori identification of groups of pregnant women exposed and unexposed to ZIKVP. This method will allow for an oversampling (even 100%) of the pregnant women with ZKVP and a optimized sampling from the general population of pregnant women unexposed to ZIKVP, saving resources in the unexposed group and improving the expected number of incident cases (outcomes) overall.ConclusionWe hope that this proposal will broaden the methodological debate on the improvement of statistical power and protocol harmonization of cohort studies that aim to evaluate the association between Zika infection during pregnancy and outcomes for the offspring, as well as those with similar objectives.