Margareth Crisóstomo Portela

Transição epidemiológica e o estudo de carga de doença no Brasil

No Brasil, a transicao epidemiologica nao tem ocorrido de acordo com o modelo experimentado pela maioria dos paises desenvolvidos. Velhos e novos problemas em saude coexistem, com predominância das doencas cronico-degenerativas, embora as doencas transmissiveis ainda desempenhem um papel importante. Neste estudo, os diferenciais, em relacao ao padrao epidemiologico, sao descritos para o Brasil e grandes regioes, para o indicador de saude dos estudos da carga de doenca, o DALY. Entre os principais resultados encontrados, para o Brasil, destaca-se que o grupo das doencas nao-transmissiveis, infecciosas/parasitarias/maternas/perinatais/nutricionais, e das causas externas representaram, respectivamente, 66,3%, 23,5% e 10,2% da carga total de doenca estimada. A utilizacao do indicador DALY propicia a identificacao de prioridades em funcao do perfil epidemiologico, facilitando a tomada de decisoes e destinacao adequada de recursos por parte dos gestores.

Child-OIDP index in Brazil: Cross-cultural adaptation and validation

BackgroundOral health-related quality of life (OHRQoL) measures are being increasingly used to introduce dimensions excluded by normative measures. Consequently, there is a need for an index which evaluates childrens OHRQoL validated for Brazilian population, useful for oral health needs assessments and for the evaluation of oral health programs, services and technologies. The aim of this study was to do a cross-cultural adaptation of the Child Oral Impacts on Daily Performances (Child-OIDP) index, and assess its reliability and validity for application among Brazilian children between the ages of eleven and fourteen.MethodsFor cross-cultural adaptation, a translation/back-translation method integrated with expert panel reviews was applied. A total of 342 students from four public schools took part of the study.ResultsOverall, 80.7% of the sample reported at least one oral impact in the last three months. Cronbachs alpha was 0.63, the weighted kappa 0.76, and the intraclass correlation coefficient (ICC) 0.79. The index had a significant association with self-reported health measurements (self-rated oral health, satisfaction with oral health, perceived dental treatment needs, self-rated general health; all p < 0.01).ConclusionIt was concluded that the Child-OIDP index is a measure of oral health-related quality of life that can be applied to Brazilian children.

Oral health-related quality of life of 11- and 12-year-old public school children in Rio de Janeiro.

OBJECTIVES The objective of this study was to assess the association between oral health-related quality of life (OHRQoL), measured through the Child-OIDP, and demographic characteristics, self-reported oral problems, and clinical oral health measures, among 11- to 12-year-old school children in the city of Rio de Janeiro, Brazil. METHODS A cross-sectional study was conducted, having as its target population 11- and 12-year-old students of both sexes, formally enrolled in 6- and 7-year school classes at public schools. A probabilistic sample with complex design was used. OHRQoL was assessed by the Brazilian version of Child-OIDP. Oral exams were conducted, and the presence of dental biofilm, gingival bleeding, DMFT, fluorosis, enamel defects, dental trauma, and malocclusion were recorded. RESULTS A total of 571 school children participated with a mean age of 12.0 years and 95% confidence interval (95% CI) from 11.9 to 12.1. A total of 88.7% of the school children presented the impact of oral problems in at least one of the eight daily performances. The activities that had most impacts were eating (81.3%), cleaning mouth (40.5%), and smiling (32.2%). The mean Child-OIDP index was 7.1 with 95% CI from 6.2 to 8.1. The highest scores were in relation to eating (mean = 25.0; 95% CI from 22.4 to 27.6), cleaning mouth (mean = 12.0; 95% CI from 9.1 to 14.9), and smiling (mean = 10.0; 95% CI from 7.5 to 12.5). In the logistic regression model, the Child-OIDP was associated with dental caries experience and with the perception of sensitive teeth, perception of gingival bleeding, and perception of inadequate position of the teeth. In the multinomial regression, we found that the odds of having higher levels of Child-OIDP were positively associated with dental caries experience. Self-reported dental caries, mobile milk teeth, tooth position, bleeding gums, and bad breath were associated with worst OHRQoL. CONCLUSIONS It can be concluded that there is an association between dental caries experience and the Child-OIDP index. This association indicates the impact of this condition on the quality of life of school children. Moreover, the Child-OIDP index is explained more by self-reported oral problems than by clinical normative measures.

Tuberculosis among indigenous populations in Rondonia, Amazonia, Brazil

Tuberculosis persists as a serious public health problem in Brazil. Prevalence rates are alarming in certain social groups, including indigenous peoples. This article presents an epidemiological analysis of records in the Rondonia State Tuberculosis Control Program, identifying the diseases profile among indigenous groups, which are socially more vulnerable and have different issues involved in controlling the disease. The study includes a descriptive statistical and multivariate multinomial analysis of cases reported in 1992 and from 1994 to 1998, attempting to identify factors associated with tuberculosis-related deaths, treatment drop-out, and missing data. Associations were identified between variables related to the disease, to the health service, and to treatment results. There is evidence that the indigenous populations in Rondonia have an increased risk of acquiring and dying from tuberculosis as compared to other residents of the State. Attention is called to the need for prevention and control measures specifically tailored to the reality of indigenous peoples.

O Sistema de Informações Hospitalares e a assistência ao infarto agudo do miocárdio

OBJECTIVE To analyze the applicability of the Brazilian Unified Health Systems national hospital database to evaluate the quality of acute myocardial infarction hospital care. METHODS It was evaluated 1,936 hospital admission forms having acute myocardial infarction (AMI) as primary diagnosis in the municipal district of Rio de Janeiro, Brazil, in 1997. Data was collected from the national hospital database. A stratified random sampling of 391 medical records was also evaluated. AMI diagnosis agreement followed the literature criteria. Variable accuracy analysis was performed using kappa index agreement. RESULTS The quality of AMI diagnosis registered in hospital admission forms was satisfactory according to the gold standard of the literature. In general, the accuracy of the variables demographics (sex, age group), process (medical procedures and interventions), and outcome (hospital death) was satisfactory. The accuracy of demographics and outcome variables was higher than the one of process variables. Under registration of secondary diagnosis was high in the forms and it was the main limiting factor. CONCLUSIONS Given the study findings and the widespread availability of the national hospital database, it is pertinent its use as an instrument in the evaluation of the quality of AMI medical care.

Regeneration of splenic autotransplants.

Abstract. Splenic autotransplantation seems to be the only alternative for preservation of splenic tissue after total splenectomy. This work was carried out to analyze the morphologic regeneration of autotransplanted splenic tissue in Wistar rats and to determine the bacterial phagocytic function of their macrophages. We utilized an experimental model including young and adult rats, of both sexes, submitted to total splenectomy combined with autotransplantation in the greater omentum of slices of the whole mass of spleen. Sixteen weeks later animals were intravenously inoculated with a suspension of Escherichia coli AB1157. There was regeneration of autotransplanted splenic tissue in all animals. A similar morphological aspect among all animals was observed, with splenic tissue showing red and white pulps with a moderate architectural disarrangement. Macrophages containing bacterial aggregates were observed, as well as macrophages with hemosiderin pigments inside the cytoplasm. Blood vessels showed preserved walls, with no signs of vasculitis or thrombosis. The present results suggest that splenic autotransplants in the greater omentum of the rat acquire the macro- and microscopic architecture of a normal spleen, with reduced dimensions, and preserve bacterial phagocyte function.

HIV testing among pregnant women in Brazil: rates and predictors

OBJECTIVE To assess rates of offering and uptake of HIV testing and their predictors among women who attended prenatal care. METHODS A population-based cross-sectional study was conducted among postpartum women (N=2,234) who attended at least one prenatal care visit in 12 cities. Independent and probabilistic samples were selected in the cities studied. Sociodemographic data, information about prenatal care and access to HIV prevention interventions during the current pregnancy were collected. Bivariate and multivariate analyses were carried out to assess independent effects of the covariates on offering and uptake of HIV testing. Data collection took place between November 1999 and April 2000. RESULTS Overall, 77.5% of the women reported undergoing HIV testing during the current pregnancy. Offering of HIV testing was positively associated with: previous knowledge about prevention of mother-to-child transmission of HIV; higher number of prenatal care visits; higher level of education and being white. HIV testing acceptance rate was 92.5%. CONCLUSIONS The study results indicate that dissemination of information about prevention of mother-to-child transmission among women may contribute to increasing HIV testing coverage during pregnancy. Non-white women with lower level of education should be prioritized. Strategies to increase attendance of vulnerable women to prenatal care and to raise awareness among health care workers are of utmost importance.OBJECTIVE: To assess rates of offering and uptake of HIV testing and their predictors among women who attended prenatal care. METHODS: A population-based cross-sectional study was conducted among postpartum women (N=2,234) who attended at least one prenatal care visit in 12 cities. Independent and probabilistic samples were selected in the cities studied. Sociodemographic data, information about prenatal care and access to HIV prevention interventions during the current pregnancy were collected. Bivariate and multivariate analyses were carried out to assess independent effects of the covariates on offering and uptake of HIV testing. Data collection took place between November 1999 and April 2000. RESULTS: Overall, 77.5% of the women reported undergoing HIV testing during the current pregnancy. Offering of HIV testing was positively associated with: previous knowledge about prevention of mother-to-child transmission of HIV; higher number of prenatal care visits; higher level of education and being white. HIV testing acceptance rate was 92.5%. CONCLUSIONS: The study results indicate that dissemination of information about prevention of mother-to-child transmission among women may contribute to increasing HIV testing coverage during pregnancy. Non-white women with lower level of education should be prioritized. Strategies to increase attendance of vulnerable women to prenatal care and to raise awareness among health care workers are of utmost importance.

[Evaluation of under-reporting of AIDS cases in the city of Rio de Janeiro based on data from the hospital information system of the Unified Health System].

Data from the Hospital Information System (SIH-SUS) were linked to data from the AIDS Case Reporting System (Sinan) to assess the level of under-reporting of AIDS cases in the city of Rio de Janeiro. A high level of unreported cases(42.7%) was observed for patients treated in hospitals under Brazils Unified Health System in the city of Rio. Bivariate analysis showed an association between reporting to the Sinan and age, principal diagnosis, and type of hospital.

Pesquisa sobre as Condições de Saúde Bucal da População Brasileira (SB Brasil 2003): seus dados não produzem estimativas populacionais, mas há possibilidade de correção

The Brazilian Oral Health Survey (SB Brazil 2003) was the most comprehensive study on oral health conditions ever conducted in Brazil. Probabilistic sampling methods were applied in order for the collected data to represent the population age groups selected in the 5 regions of the country. However, this was not possible because the sampling process was never concluded, which would require estimation of the sample weights and identification of the samples other structural variables (selection strata and primary sampling units). This paper describes the SB Brazil 2003 sample design, formulates the inclusion probabilities in the multiple selection stages, and proposes strategies for estimating the sample weights. The strategy to define the sample weights and identify the samples structural variables hinges on retrieving data that should have been recorded in the reports produced during the survey, and in their absence, in information available from the Brazilian Institute of Geography and Statistics (IBGE) and Ministry of Education and Culture (MEC), as valid proxies.

[Health care to HIV/AIDS patients in Brazil].

This study was intended to assess care provided to those living with HIV/AIDS in Brazil and the Brazilian Unified Health System (SUS) capacity of delivering interventions to cope with the epidemic as well as to discuss the sustainability of the Brazilian initiative of providing universal free access to antiretrovirals (ARVs). Original data from a study comprising 119 respondents on the potential capacity of delivering a prospective HIV vaccine in Brazil was used. Inpatient and pharmaceutical care was based on data from the SUS Hospital Information System and Drug Logistics Management Systems of the National Program for STD/AIDS. The study results indicate good performance of the Brazilian ARV Access Program but access to treatment of opportunistic infections was, however, unsatisfactory. The rates covered by SUS for AIDS hospital admissions remained very low, on average around R