Marco Antonio Ratzsch de Andreazzi

Vivência de violência entre escolares brasileiros: resultados da Pesquisa Nacional de Saúde do Escolar (PeNSE)

This article presents the main results of the National Adolescent School-based Health Survey (PeNSE). A questionnaire was applied to a sample of 60,973 students of the 9th year of Junior high school in public and private schools of the Brazilian state capitals and the Federal District, between March and June 2009. The prevalence and confidence interval of 95% (CI 95%) of the violence situations involving adolescents were analyzed. The following situations were identified: lack of safety on the way home-school (6.4%; CI95%: 6.1%-6.8%) and at school (5.5%; CI95%: 5.2%-5.8%); involving fights with physical aggression (12.9%; CI95%: 12.4%-13.4%), with knife (6.1%; CI95%: 5.7%-6.4%) or fire arm (4.0%; CI95%: 3.7%-4.3%); physical aggression by family member (9.5%; CI95%: 9.1%-9.9%). Violence situations were more prevalent among male students. There were great variations among the cities studied. Adolescents are exposed to different violence manifestations in the institutions that supposedly must assure their protection and healthy development: school and the home. These results aim to support health promotion measures and prevention of these risk factors.

Trend of the risk and protective factors of chronic diseases in adolescents, National Adolescent School-based Health Survey (PeNSE 2009 e 2012)

OBJECTIVE To compare the prevalence of major risk and protection factors for chronic non-communicable diseases in school-aged children in Brazilian capitals surveyed in the National Adolescent School-based Health Survey in its two editions, 2009 and 2012. METHODS The frequencies, with Confidence Interval of 95%, of the following demographic variables were compared: food intake, body image, physical activity, smoking, alcohol and other drugs. Prevalence was compared in the two editions of the survey. RESULTS The proportion of students who attend two physical education classes a week was maintained at 49% between 2009 and 2012, increasing in public schools from 50.6% (95%CI 49.8 - 51.4) to 52.5% (95%CI 49.2 - 55.7), and decreasing in private schools. There was no change in the proportion of students who watch two hours or more of television daily, about 80%. As for body image, there was no change between the two editions, and about 60% considered themselves being of normal weight. There was a reduction in the percentage of adolescents who experienced cigarettes, from 24.2% (95%CI 23.6 - 24.8) to 22.3% (95%CI 21.4 - 23.2), and the prevalence of smoking was maintained at about 6% (there was no statistical difference between 2009 and 2012). The consumption of beans, fruits, sweets and soft drinks also decreased. Frequency of drug experimentation was of 8.7% (95%CI 8.3 - 9.1) in 2009, and 9.6% (95%CI 9.0 - 10.3) in 2012, with no difference between confidence intervals, and the frequency of alcohol experimentation was maintained at about 70%; the percentage of use in the past 30 days was also maintained at around 27%. CONCLUSION In the Brazilian capitals, the vast majority of prevalence of risk factors were kept stable in the two editions of the National Survey of School. These data generate evidence to guide the implementation of public policies to minimize the exposure of adolescents to risk factors.

Prevalence of asthma symptoms among adolescents in Brazil: National Adolescent School-based Health Survey (PeNSE 2012)

OBJECTIVE This study aims to describe the prevalence rates of asthma symptoms in Brazil, its Regions and State capitals, according to data from the National Adolescent School-based Health Survey, 2012. Furthermore, it aims to compare the prevalence of asthma in the capitals evaluated by PeNSE 2012 with previous results of the International Study of Asthma and Allergies in Childhood (ISAAC). METHODS Cross sectional study of 9th grade students at public and private schools of all Brazilian states and the Federal District (Brasília). A self reported questionnaire containing items from the ISAAC was applied in order to identify the presence of asthma symptoms. RESULTS The results of PeNSE indicate a high prevalence of asthma symptoms (23.2%) and of reports of a previous medical diagnosis of asthma (12.4%). Of the five state capitals in which the PeNSE results were compared to the ISAAC, São Paulo, Curitiba and Porto Alegre presented an increase in the prevalence of asthma symptoms. In Salvador, there was a reduction. CONCLUSION Brazil is among the countries with the highest prevalence of asthma in the world, and the prevalence is still growing.

Capital dynamics and local healthcare systems: searching for a comprehensive analysis of the health sector

The article presents a proposal of a methodology aimed to analyze the health care sector according to the dynamics of capital accumulation. That approach could be summed up to more traditional approaches founded in the Public Health field, based in a political perspective. The proposal departs from concepts and methods of Industrial Organization, already used for health care markets, in the European and Latin-American (CEPAL) contexts. We aggregated economic and historical variables to these approaches, which delimitate possibilities and impose constraints to the strategies of the local agents. The objective of the paper is to give methodological support to public managers at state and local level, whose role as the single commander in their territories is prescribed by the present health policy in Brazil. That includes all the fields related to private sector regulation in health: from planning the supply to quality control of providers.Apresenta-se uma proposta metodologica direcionada a analise dos determinantes da oferta de atencao a saude, com base na dinâmica da acumulacao de capital a ser agregada aos elementos de definicao das politicas de saude mais convencionalmente empregados na area da Saude Coletiva. A analise esta baseada nos conceitos e metodos da Economia Industrial, ja testados para o setor saude em trabalhos desenvolvidos no âmbito europeu e por pesquisadores da CEPAL, aos quais se propoem agregar variaveis do contexto geral, que condicionam possibilidades e impoem limites as estrategias dos agentes locais, e analises de corte historico que permitam identificar rugosidades. Destina-se a apoiar os gestores do SUS, estaduais e municipais, na sua atribuicao de comando unico do setor saude sobre um determinado territorio, o que inclui o conjunto das possibilidades de regulacao do setor privado - do planejamento da oferta ao controle de qualidade.

Dinâmica do capital e sistemas locais de saúde: em busca de uma análise integradora do setor saúde

The article presents a proposal of a methodology aimed to analyze the health care sector according to the dynamics of capital accumulation. That approach could be summed up to more traditional approaches founded in the Public Health field, based in a political perspective. The proposal departs from concepts and methods of Industrial Organization, already used for health care markets, in the European and Latin-American (CEPAL) contexts. We aggregated economic and historical variables to these approaches, which delimitate possibilities and impose constraints to the strategies of the local agents. The objective of the paper is to give methodological support to public managers at state and local level, whose role as the single commander in their territories is prescribed by the present health policy in Brazil. That includes all the fields related to private sector regulation in health: from planning the supply to quality control of providers.Apresenta-se uma proposta metodologica direcionada a analise dos determinantes da oferta de atencao a saude, com base na dinâmica da acumulacao de capital a ser agregada aos elementos de definicao das politicas de saude mais convencionalmente empregados na area da Saude Coletiva. A analise esta baseada nos conceitos e metodos da Economia Industrial, ja testados para o setor saude em trabalhos desenvolvidos no âmbito europeu e por pesquisadores da CEPAL, aos quais se propoem agregar variaveis do contexto geral, que condicionam possibilidades e impoem limites as estrategias dos agentes locais, e analises de corte historico que permitam identificar rugosidades. Destina-se a apoiar os gestores do SUS, estaduais e municipais, na sua atribuicao de comando unico do setor saude sobre um determinado territorio, o que inclui o conjunto das possibilidades de regulacao do setor privado - do planejamento da oferta ao controle de qualidade.

Supply and usage of hemodynamic services in the state of Rio de Janeiro, Brazil

OBJECTIVE To analyze the supply of equipment and procedures inherent to public hemodynamic services in the State of Rio de Janeiro, Brazil. METHODS We conducted an exploratory study based on official data banks: AMS survey of IBGE, CNES, AIH and APAC, and ANS. The examination period of the supply was from 1999 to 2009, and of the use, from 2008 to October 2012. RESULTS Since 1999 there has been a growth in the acquisition of hemodynamic equipment. The private sector concentrates most of the offer, but has been reducing its availability to the Unified Health System (SUS). The ratio of the equipment and the population exceeds that of some rich countries. On the supply side, there was, in Rio de Janeiro, in 2009, a rate of 4.1 units per million inhabitants, higher than in Brazil as a whole, of 3.4; however, when considering only the offer for the SUS (SUS), the values are similar, 1.6 and 1.5. CONCLUSION The procedures of interventional cardiology grew between 2008 and 2011 in Rio de Janeiro, but the majority of public hospitals have reduced production and the private have increased it, resulting in the referral of SUS users to be submitted to procedures great distances from home.

Dinamica del capital y sistemas locales de salud: en búsqueda de un análisis integrador del sector salud

The article presents a proposal of a methodology aimed to analyze the health care sector according to the dynamics of capital accumulation. That approach could be summed up to more traditional approaches founded in the Public Health field, based in a political perspective. The proposal departs from concepts and methods of Industrial Organization, already used for health care markets, in the European and Latin-American (CEPAL) contexts. We aggregated economic and historical variables to these approaches, which delimitate possibilities and impose constraints to the strategies of the local agents. The objective of the paper is to give methodological support to public managers at state and local level, whose role as the single commander in their territories is prescribed by the present health policy in Brazil. That includes all the fields related to private sector regulation in health: from planning the supply to quality control of providers.Apresenta-se uma proposta metodologica direcionada a analise dos determinantes da oferta de atencao a saude, com base na dinâmica da acumulacao de capital a ser agregada aos elementos de definicao das politicas de saude mais convencionalmente empregados na area da Saude Coletiva. A analise esta baseada nos conceitos e metodos da Economia Industrial, ja testados para o setor saude em trabalhos desenvolvidos no âmbito europeu e por pesquisadores da CEPAL, aos quais se propoem agregar variaveis do contexto geral, que condicionam possibilidades e impoem limites as estrategias dos agentes locais, e analises de corte historico que permitam identificar rugosidades. Destina-se a apoiar os gestores do SUS, estaduais e municipais, na sua atribuicao de comando unico do setor saude sobre um determinado territorio, o que inclui o conjunto das possibilidades de regulacao do setor privado - do planejamento da oferta ao controle de qualidade.