Maria Luiza Carvalho de Lima

Panorama da violência urbana no Brasil e suas capitais

Neste artigo, faz-se uma analise epidemiologica descritiva da morbidade e da mortalidade por acidentes e violencia no Brasil e suas capitais, em anos mais recentes para os quais as informacoes estao disponiveis. Usam-se dados dos Sistemas de Informacoes sobre Mortalidade e de Internacoes Hospitalares, do Ministerio da Saude; da Secretaria Nacional de Seguranca, do Ministerio da Justica; e do Departamento Nacional de Trânsito, do Ministerio das Cidades. Os dados populacionais de 2002 e 2003 sao os disponibilizados pelo Datasus/MS. Destacam-se algumas situacoes que persistem no Brasil: elevadas taxas de homicidios e de mortes por acidentes de trânsito; concentracao dos eventos na populacao jovem, negra e do sexo masculino; e a complexidade e multideterminacao desses fenomenos. Como novo, aponta-se um processo de disseminacao de homicidios para outros municipios das regioes metropolitanas e do interior dos Estados, com destaque para a magnitude da morbidade em relacao a mortalidade. Porto Velho, Macapa, Vitoria, Rio de Janeiro e Cuiaba apresentam os maiores indicadores de violencia intencional - elevadas taxas de homicidios e de lesoes corporais. Em Palmas ocorrem altas taxas de mortalidade por acidentes de transporte e de vitimas nao fatais por 10 mil veiculos.

Prevalence and risk factors of Hepatitis C virus infection in Brazil, 2005 through 2009: a cross-sectional study

BackgroundHepatitis C chronic liver disease is a major cause of liver transplant in developed countries. This article reports the first nationwide population-based survey conducted to estimate the seroprevalence of HCV antibodies and associated risk factors in the urban population of Brazil.MethodsThe cross sectional study was conducted in all Brazilian macro-regions from 2005 to 2009, as a stratified multistage cluster sample of 19,503 inhabitants aged between 10 and 69 years, representing individuals living in all 26 State capitals and the Federal District. Hepatitis C antibodies were detected by a third-generation enzyme immunoassay. Seropositive individuals were retested by Polymerase Chain Reaction and genotyped. Adjusted prevalence was estimated by macro-regions. Potential risk factors associated with HCV infection were assessed by calculating the crude and adjusted odds ratios, 95% confidence intervals (95% CI) and p values. Population attributable risk was estimated for multiple factors using a case–control approach.ResultsThe overall weighted prevalence of hepatitis C antibodies was 1.38% (95% CI: 1.12%–1.64%). Prevalence of infection increased in older groups but was similar for both sexes. The multivariate model showed the following to be predictors of HCV infection: age, injected drug use (OR = 6.65), sniffed drug use (OR = 2.59), hospitalization (OR = 1.90), groups socially deprived by the lack of sewage disposal (OR = 2.53), and injection with glass syringe (OR = 1.52, with a borderline p value). The genotypes 1 (subtypes 1a, 1b), 2b and 3a were identified. The estimated population attributable risk for the ensemble of risk factors was 40%. Approximately 1.3 million individuals would be expected to be anti-HCV-positive in the country.ConclusionsThe large estimated absolute numbers of infected individuals reveals the burden of the disease in the near future, giving rise to costs for the health care system and society at large. The known risk factors explain less than 50% of the infected cases, limiting the prevention strategies. Our findings regarding risk behaviors associated with HCV infection showed that there is still room for improving strategies for reducing transmission among drug users and nosocomial infection, as well as a need for specific prevention and control strategies targeting individuals living in poverty.

Multilevel analysis of hepatitis A infection in children and adolescents: a household survey in the Northeast and Central-west regions of Brazil

Background The objectives were to estimate the prevalence of hepatitis A among children and adolescents from the Northeast and Midwest regions and the Federal District of Brazil and to identify individual-, household- and area-levels factors associated with hepatitis A infection. Methods This population-based survey was conducted in 2004–2005 and covered individuals aged between 5 and 19 years. A stratified multistage cluster sampling technique with probability proportional to size was used to select 1937 individuals aged between 5 and 19 years living in the Federal capital and in the State capitals of 12 states in the study regions. The sample was stratified according to age (5–9 and 10- to 19-years-old) and capital within each region. Individual- and household-level data were collected by interview at the home of the individual. Variables related to the area were retrieved from census tract data. The outcome was total antibodies to hepatitis A virus detected using commercial EIA. The age distribution of the susceptible population was estimated using a simple catalytic model. The associations between HAV infection and independent variables were assessed using the odds ratio and corrected for the random design effect and sampling weight. Multilevel analysis was performed by GLLAMM using Stata 9.2. Results The prevalence of hepatitis A infection in the 5–9 and 10–19 age-group was 41.5 and 57.4%, respectively for the Northeast, 32.3 and 56.0%, respectively for the Midwest and 33.8 and 65.1% for the Federal District. A trend for the prevalence of HAV infection to increase according to age was detected in all sites. By the age of 5, 31.5% of the children had already been infected with HAV in the Northeast region compared with 20.0% in the other sites. By the age of 19 years, seropositivity was ∼70% in all areas. The curves of susceptible populations differed from one area to another. Multilevel modeling showed that variables relating to different levels of education were associated with HAV infection in all sites. Conclusion The study sites were classified as areas with intermediate endemicity area for hepatitis A infection. Differences in age trends of infection were detected among settings. This multilevel model allowed for quantification of contextual predictors of hepatitis A infection in urban areas.

The panorama of urban violence in Brazil and its capitals

This article presents a descriptive epidemiological analysis of accidents and violence in Brazil and in the Brazilian capitals in recent years. The data u...

Methodology of a nationwide cross-sectional survey of prevalence and epidemiological patterns of hepatitis A, B and C infection in Brazil

A population-based survey to provide information on the prevalence of hepatitis viral infection and the pattern of risk factors was carried out in the urban population of all Brazilian state capitals and the Federal District, between 2005 and 2009. This paper describes the design and methodology of the study which involved a population aged 5 to 19 for hepatitis A and 10 to 69 for hepatitis B and C. Interviews and blood samples were obtained through household visits. The sample was selected using stratified multi-stage cluster sampling and was drawn with equal probability from each domain of study (region and age-group). Nationwide, 19,280 households and ~31,000 residents were selected. The study is large enough to detect prevalence of viral infection around 0.1% and risk factor assessments within each region. The methodology seems to be a viable way of differentiating between distinct epidemiological patterns of hepatitis A, B and C. These data will be of value for the evaluation of vaccination policies and for the design of control program strategies.

Violência e morte: diferenciais da mortalidade por causas externas no espaço urbano do Recife, 1991

This study aimed to describe the amount of (and trends in) violent deaths in the city of Recife, Pernambuco, Brazil, and to analyze their determinants. The article presents the spatial distribution of these deaths for the year 1991 and the differences regarding sex, age, and place of occurrence. It also analyzes the potential role of a series of socioeconomic factors, used as indicators of the populations living conditions. An exploratory ecological study was conducted to compare various groups. In 1991 there were a total of 1181 violent deaths in Recife. The study points to an overall mortality rate from external causes of 90.9/ 100,000 inhabitants. The two age groups 10-39 years and 60 years and over were those at highest risk of death. Males showed excess mortality in all age groups. The most important specific causes of death were homicides and traffic accidents, with 51.3% and 23.4%, respectively, of all violent deaths. The authors discuss the differences in the mortality rate from external causes in different social areas, defined according to living conditions and their relationship to the history of the development of Recife.Este estudo teve como objetivo descrever a tendencia e a magnitude das mortes violentas na cidade do Recife, sua distribuicao espacial no ano de 1991 e seus diferenciais quanto ao sexo, idade, local de ocorrencia; objetivou, tambem, analisar a participacao de algumas variaveis socio-economicas que expressam as condicoes de vida, nas possiveis explicacoes dessas diferencas. Utilizou-se como metodo o desenho de estudo ecologico do tipo exploratorio e comparacao de multiplos grupos. Foram analisadas 1.181 declaracoes de obitos de residentes em Recife, falecidos no ano de 1991. Verificou-se uma magnitude do coeficiente de mortalidade por causas externas na ordem de 90,9 por cem mil habitantes. Os grupos de dez a 39 anos e sessenta anos e mais constituiram os de maior risco, e o sexo masculino apresentou uma sobremortalidade em todas as faixas etarias. Os principais grupos de causas especificas foram os homicidios e os acidentes de trânsito, que representaram cerca de 51,3% e 23,4% do total de obitos por essas causas, respectivamente. Discutiram-se alguns aspectos da desigualdade da mortalidade por causas externas nos espacos sociais, segundo condicoes de vida e sua relacao com o processo historico de formacao da cidade do Recife.

Estudo espacial da mortalidade por acidentes de motocicleta em Pernambuco

OBJETIVO: Analisar a distribuicao espacial da mortalidade por acidentes de motocicleta no estado de Pernambuco. METODOS: Estudo ecologico de base populacional, usando os dados de mortalidade por acidentes de motocicletas ocorridos de 01/01/2000 a 31/12/2005. As unidades de analise foram municipios. Para a analise da distribuicao espacial dos obitos foram construidos coeficientes medios de mortalidade, tendo como numerador os obitos por acidentes de motocicletas registrados no Sistema de Informacoes sobre Mortalidade e, como denominador, a populacao do centro do periodo. Utilizaram-se tecnicas de analise espacial, suavizacao do coeficiente pelo metodo bayesiano empirico local e o diagrama de espalhamento de Moran, aplicados sobre a base cartografica digital do estado. RESULTADOS: O coeficiente medio de mortalidade por acidentes de motocicletas em Pernambuco foi de 3,47/100 mil habitantes. Dos 185 municipios, 16 faziam parte de cinco conglomerados identificados com coeficientes de mortalidade que variaram de 5,66 a 11,66/100 mil habitantes, considerados areas criticas. Tres dessas areas localizam-se na regiao de desenvolvimento sertao e duas no agreste. CONCLUSOES: O risco de morrer por acidente de motocicleta e maior nas areas de conglomerado em regioes fora do eixo metropolitano, sugerindo medidas de intervencao que considerem o contexto de desenvolvimento economico, social e cultural.OBJECTIVE To analyze the spatial distribution of mortality due to motorcycle accidents in the state of Pernambuco, Northeastern Brazil. METHODS A population-based ecological study using data on mortality in motorcycle accidents from 01/01/2000 to 31/12/2005. The analysis units were the municipalities. For the spatial distribution analysis, an average mortality rate was calculated, using deaths from motorcycle accidents recorded in the Mortality Information System as the numerator, and as the denominator the population of the mid-period. Spatial analysis techniques, mortality smoothing coefficient estimate by the local empirical Bayesian method and Moran scatterplot, applied to the digital cartographic base of Pernambuco were used. RESULTS The average mortality rate for motorcycle accidents in Pernambuco was 3.47 per 100 thousand inhabitants. Of the 185 municipalities, 16 were part of five clusters identified with average mortality rates ranging from 5.66 to 11.66 per 100 thousand inhabitants, and were considered critical areas. Three clusters are located in the area known as sertão and two in the agreste of the state. CONCLUSIONS The risk of dying from a motorcycle accident is greater in conglomerate areas outside the metropolitan axis, and intervention measures should consider the economic, social and cultural contexts.

Fatores associados à cárie dentária em pré-escolares do Recife, Pernambuco, Brasil

To investigate factors associated with dental caries in deciduous dentition, a nested case-control study was conducted in a prevalence survey of preschool children (n = 1,690) aged 18 to 36 months and 5 years of age, treated under the Family Health Program in Recife, Pernambuco State, Brazil, in 2006. Cases were children with dmft > 1 and controls with dmft = 0. The independent variables were analyzed in blocks: demographic, environmental, family structure, health care, and dental services use. OR and 95%CI were estimated. Variables associated with the outcome at p < 0.20 in the univariate analysis were included in a multivariate logistic regression model. The cutoff for remaining in the final model was p < 0.10. Larger households (more members), lack of running supply, time of residence, maternal (or caregivers) schooling, attendance in public preschool, demand for dental services, and sugar intake patterns were associated factors. Variables related to social context were the main predictors of caries, thus highlighting the need for comprehensive measures to address other common childhood health problems.

Diagnostic characterization of services providing care to victims of accidents and violence in five Brazilian state capitals

This article characterizes the services providing care to victims in five Brazilian regions with high violence and accident rates. It analyzes care activities and strategies, the profile of the teams, the conditions of installations, equipment and supplies, integrated care and registration services and the opinion of health managers with respect to the needs and requirements for a better care to the victims. The sample is composed by 103 services: 34 from Recife, 25 from Rio de Janeiro, 18 from Manaus, 18 from Curitiba and 8 from Brasilia. The still preliminary results indicate: lower number of services focusing on the elderly; scarce investment in preventive actions; the principal actions carried out are social assistance, ambulatory and hospital care and psychological assistance; patients received from Basic Health Units require attention of the communities and families; need for investment in capacity building programs for professionals; precarious registries, data handled manually. The wording of the National Policy for Reduction of Morbidity and Mortality from Accidents and Violence is not well-known and there is a lack of articulation among and inside sectors and between prehospital and emergency care services. Rehabilitation services are insufficient in all cities.

Caracterização diagnóstica dos serviços que atendem vítimas de acidentes e violências em cinco capitais brasileiras

Este artigo caracteriza servicos que atendem as vitimas em capitais das cinco regioes brasileiras com altos indices de violencias e acidentes.Analisam-se atividades e estrategias de atendimento, perfil das equipes, condicoes das instalacoes, equipamentos e insumos, servicos integrados de atencao e de registro de agravos e a otica de gestores de saude sobre demandas e necessidades para uma atencao de qualidade as vitimas. O acervo se constitui de 103 servicos: 34 de Recife, 25 do Rio de Janeiro, 18 de Manaus, 18 de Curitiba e 8 de Brasilia. Os resultados ainda preliminares indicam: menor numero de servicos com atendimentos voltados a idosos; pouco investimento em acoes de prevencao; suporte social, atendimento ambulatorial, hospitalar e psicologico sao as principais acoes empreendidas; encaminhamentos das unidades basicas de saude requerem atencao nas comunidades e familias; necessidade de investimentos na capacitacao dos profissionais para atendimento; registros precarios e feitos manualmente. O texto da Politica Nacional de Reducao de Morbimortalidade por Acidentes e Violencias e pouco conhecido e ha desarticulacao inter e intra-institucional e entre atendimento pre-hospitalar e de emergencia. Em todas as cidades ha insuficiencia de servicos de reabilitacao.