Neir Antunes Paes

Doenças infecciosas e parasitárias no Brasil: uma década de transição

Brazil has been undergoing a period of epidemiological and demographic transition, which has included an improvement in the quality of death certificate registrations and major changes in the patterns of mortality from infectious and parasitic diseases. This article outlines the changes in the mortality patterns that were observed in the country and in its states during the decade of the 1980s. We used data from the Ministry of Health Mortality Information System, classified according to the International Classification of Diseases, 9th Revision. Our analysis showed important changes in mortality patterns in Brazil. Mortality from infectious diseases decreased by 41% among men and by 44% among women. While these types of changes were especially noticeable in the states of the North and Northeast, these states still have the highest mortality rates in the country. The changes particularly affected the extreme limits of the age continuum, most especially children under 1 year of age. Within the group of infectious and parasitic diseases, we also assessed the mortality due to intestinal infectious diseases, tuberculosis, and septicemia. We found that in the 1980s there was a major decrease in the rates of mortality due to intestinal infectious diseases and to tuberculosis. However, there was an increase in the risk of death from septicemia during the decade. In conclusion, we find that the rate of mortality caused by infectious and parasitic diseases remains high in Brazil. Therefore, Brazilian health authorities still need to give priority attention to this cause of death.

Recuperação das principais causas de morte do Nordeste do Brasil: impacto na expectativa de vida

OBJECTIVE To estimate the impact on life expectancy after elimination of the main groups of causes of death in the Brazilian Northeast in 2000. METHODS Data on deaths recorded for the states of Northeastern Brazil in 2000 were extracted from the Mortality Information System. The coverage of death records of children under ten years of age was assessed using indirect procedures. Ledermanns method was used to reclassify the ill-defined death causes, according to sex. Multiple-decrement life tables were constructed for the main groups of causes of death, whose decrement impacts were assessed through life expectancy. RESULTS The total elimination of the main groups of causes in the general mortality resulted in the following gains on the life expectancy of the Northeast for men and women, respectively: infectious and parasitic diseases (1.0 and 0.5 years), malignant neoplasms (1.4 and 1.5 years), circulatory diseases (4.0 and 4.0 years), respiratory diseases (1.1 and 0.8 years), and external causes (2.9 and 0.3 years). CONCLUSIONS The levels of death coverage were found satisfactory, as well as the reclassifications of ill-defined causes for the states. Considering the fact that the vital statistics of the Northeast have not been widely used, due to the argument that their quality limits derivation of reliable mortality indicators, their recovery in a direct way yields consistent results.OBJETIVO: Estimar o impacto na esperanca de vida apos a eliminacao dos principais grupos de causas de morte no Nordeste brasileiro em 2000. METODOS: Dados sobre os obitos registrados para os estados do Nordeste do Brasil em 2000 foram extraidos do Sistema de Informacoes sobre Mortalidade. Foram avaliadas as coberturas dos registros de obitos menores de dez anos usando procedimentos indiretos. Empregou-se o metodo de Ledermann de redistribuicao das causas de morte mal definidas, segundo o sexo. Construiram-se tabuas de vida de multiplo decremento para os principais grupos de causas de morte, cujos impactos dos decrementos foram avaliados pela esperanca de vida. RESULTADOS: A eliminacao total dos principais grupos de causas na mortalidade geral proporcionou para homens e mulheres, respectivamente, os seguintes ganhos na esperanca de vida do Nordeste: doencas infecciosas e parasitarias (1,0 e 0,5 anos), neoplasmas malignos (1,4 e 1,5 anos), doencas do aparelho circulatorio (4,0 e 4,0 anos), doencas do aparelho respiratorio (1,1 e 0,8 anos) e causas externas (2,9 e 0,3 anos). CONCLUSOES: Os niveis das coberturas dos obitos foram aceitaveis, assim como as redistribuicoes das causas mal definidas para os estados. Considerando que as estatisticas vitais do Nordeste sao pouco utilizadas, devido aos argumentos de que sua qualidade limita a producao de indicadores confiaveis da mortalidade, sua recuperacao de forma direta possibilita resultados consistentes.

Desejo, intenção e comportamento na saúde reprodutiva: a prática da cesárea em cidade do Nordeste do Brasil

OBJETIVO: investigar os fatores determinantes da alta incidencia do parto cesareo e a sua inter-relacao com a esterilizacao. METODOS: a pesquisa e parte de estudo multicentrico sobre saude reprodutiva no Brasil, realizado de 1998 a 2000, que incluiu os estados do Rio Grande do Norte, Minas Gerais, Sao Paulo e Rio Grande do Sul. Caracterizou-se como longitudinal prospectivo, no qual foram entrevistadas mulheres, provenientes do servico publico e do privado, em tres momentos: no inicio da gravidez (ate a 22a. semana de gestacao), no final (entre 30 e 40 dias antes da data provavel do parto) e apos o nascimento do bebe (entre 15 e 45 dias pos-parto). As entrevistadas deveriam satisfazer aos criterios de elegibilidade: ter entre 18 e 40 anos e residir e ter o filho no municipio de Natal. Foram realizadas 433 entrevistas no primeiro momento, 380 no segundo e 269 no terceiro. Os dados foram submetidos ao teste x2 a uma significância de a=5%, para comprovacao da associacao entre as variaveis anos de estudo (de 0 a 8 e 9 ou +) e as variaveis representativas da saude reprodutiva. RESULTADOS: das entrevistadas que tiveram seguimento (269), 119 tiveram parto por cesarea (55% do setor privado), sendo 45% previamente marcadas e 60% delas dias antes do parto. Os resultados revelaram relacao estatisticamente significante (p<0,05) entre a escolaridade e as variaveis paridade, servico procurado, classe social, estarem trabalhando e consultas de pre-natal. Assim, ficou demonstrado que a maior escolaridade predomina entre aquelas mulheres provenientes do servico privado, de classe social mais elevada e com maior numero de consultas de pre-natal. Embora sem significância estatistica, observou-se para as mulheres desse servico uma maior realizacao do parto cesareo, provavelmente pela facilidade da interacao entre o medico e a paciente, quando o desejo pela cesarea e frustrado para 43% daquelas provenientes do servico publico, bem como o desejo para fazer uma ligadura de trompas na hora do parto (57%). CONCLUSOES: esses resultados mostraram os grandes diferenciais existentes entre as categorias publico e privado, demonstrando um claro favorecimento do setor privado, e que a pratica obstetrica no Brasil, precisa mudar e melhorar, tanto entre aquelas mulheres com acesso ao servico privado, que conseguem a realizacao da cesarea sem consistentes indicacoes medicas, quanto entre as mulheres com acesso ao servico publico, que enfrentam dificuldades para realizacao desse procedimento, mesmo com procedentes indicacoes medicas, de modo a proporcionar igualdade no direito reprodutivo dessas mulheres.

Mortalidade materna no estado da Paraíba: associação entre variáveis

La mortalidad materna se ha constituido en uno de los problemas prioritarios de la salud publica, afectando directamente a mujeres en el ciclo gravido-puerperal, pertenecientes a las clases sociales menos favorecidas. Ante esta situacion, el objetivo de este estudio consistio en identificar asociaciones entre la raza de mujeres residentes en el estado de Paraiba - Brasil y las variables de grupo etario, escolaridad, y tipo de defuncion de las mujeres que fallecieron por muerte materna en el periodo de 2000 a 2004. Se trata de un estudio transversal, en el que se utilizaron como fuente de datos 109 partidas de defuncion maternas. Se procedio a un analisis estadistico bivariado y multivariado para evaluar la asociacion existente entre las variables a traves de la regresion logistica multiple. Se calculo el odds ratio para investigar la asociacion entre las variables. Se observo que no hubo significatividad estadistica entre las variables raza y edad, asi como con escolaridad, pero existieron indicios significativos de que las mujeres no blancas de Paraiba tuvieron mayores posibilidades de fallecer por muerte obstetrica directa (OR=3,55, IC: 1,20-10,5). Los resultados demostraron que el riesgo de mortalidad materna en Paraiba fue mayor entre las mujeres no blancas, dando forma asi a una importante expresion de desigualdad social.Maternal mortality has been established as one of the priority problems of public health, directly affecting women in the pregnant puerperal cycle and belonging to underprivileged social classes. Considering this situation, the aim of the present study was to identify associations between the race of women living in the state of Paraíba and age, educational level and type of death of women who died of maternal death in the period 2000 to 2004. This cross-sectional study used as a source of data declarations of 109 maternal deaths. Bivariate and multivariate statistical analyses were performed to evaluate the association between variables using multiple logistic regression. The odds ratio to investigate the association between variables was calculated. It was observed that there was no statistical significance between race and age variables or with educational level, but there was significant evidence that nonwhite women from Paraíba were more likely to die from direct obstetric death than white women, (OR = 3.55; IC: 1.20-10.5). The results showed that the risk of maternal mortality in Paraiba was higher among non-white women, revealing an important expression of social inequality.

Birth statistics and maternal and infant risk factors in the micro-regions of Northeast Brazil: a factor analysis study

Historically, birth registration in Northeast Brazil has presented serious quality problems, with major regional variations and gaps in knowledge. The current study proposes to evaluate the quality of birth records and identify patterns of relationships between variables that reflect maternal and infant factors in the birth certificates and allow summarizing the data on live births in the 188 micro-regions of the Northeast in 2000, based on factor analysis. Data on live births were collected through the Information System on Live Births (SINASC). In general, regional distribution of birth coverage suggests an increase in the southern States of the Northeast. Quality of completion of variables in the micro-regions of the Northeast was considered satisfactory. In the factor analysis, data for the variables were reduced to two factors: favorable and unfavorable to delivery.

Controle pressórico e adesão/ vínculo em hipertensos usuários da atenção primária à saúde.

This is a population-based, descriptive, and analytic study conducted with a randomized and probabilistic sample comprising 340 hypertensive individuals representative of the Family Health Strategy (FHS) Service in Joio Pessoa, PB, Brazil. The present study corresponds to the first part of a cohort started in 2008. The instrument used was an adaptation of the Primary Care Assessment Tool revalidated in Brazil. Logistic regression was used to investigate the associations between blood pressure (BP) control, sociodemographic variables, and an indicator of adherence/ attachment. Among the 340 hypertensive participants, 32.6% were followed up at the FHS, and 89.1% exhibited satisfactory adherence/ attachment. The older adults were more likely to control BP, which suggests a more accurate self-care perception and greater adherence to treatment. The present study highlights the problem posed by the control of hypertension by means of the assessment of services. We expected the present model to be applied at other locations to generate parameters to compare different municipalities.

Blood pressure control and adherence/attachment in hypertensive users of Primary Healthcare

This is a population-based, descriptive, and analytic study conducted with a randomized and probabilistic sample comprising 340 hypertensive individuals representative of the Family Health Strategy (FHS) Service in Joio Pessoa, PB, Brazil. The present study corresponds to the first part of a cohort started in 2008. The instrument used was an adaptation of the Primary Care Assessment Tool revalidated in Brazil. Logistic regression was used to investigate the associations between blood pressure (BP) control, sociodemographic variables, and an indicator of adherence/ attachment. Among the 340 hypertensive participants, 32.6% were followed up at the FHS, and 89.1% exhibited satisfactory adherence/ attachment. The older adults were more likely to control BP, which suggests a more accurate self-care perception and greater adherence to treatment. The present study highlights the problem posed by the control of hypertension by means of the assessment of services. We expected the present model to be applied at other locations to generate parameters to compare different municipalities.

Maternal mortality in the state of Paraíba-Brazil: association between variables

La mortalidad materna se ha constituido en uno de los problemas prioritarios de la salud publica, afectando directamente a mujeres en el ciclo gravido-puerperal, pertenecientes a las clases sociales menos favorecidas. Ante esta situacion, el objetivo de este estudio consistio en identificar asociaciones entre la raza de mujeres residentes en el estado de Paraiba - Brasil y las variables de grupo etario, escolaridad, y tipo de defuncion de las mujeres que fallecieron por muerte materna en el periodo de 2000 a 2004. Se trata de un estudio transversal, en el que se utilizaron como fuente de datos 109 partidas de defuncion maternas. Se procedio a un analisis estadistico bivariado y multivariado para evaluar la asociacion existente entre las variables a traves de la regresion logistica multiple. Se calculo el odds ratio para investigar la asociacion entre las variables. Se observo que no hubo significatividad estadistica entre las variables raza y edad, asi como con escolaridad, pero existieron indicios significativos de que las mujeres no blancas de Paraiba tuvieron mayores posibilidades de fallecer por muerte obstetrica directa (OR=3,55, IC: 1,20-10,5). Los resultados demostraron que el riesgo de mortalidad materna en Paraiba fue mayor entre las mujeres no blancas, dando forma asi a una importante expresion de desigualdad social.Maternal mortality has been established as one of the priority problems of public health, directly affecting women in the pregnant puerperal cycle and belonging to underprivileged social classes. Considering this situation, the aim of the present study was to identify associations between the race of women living in the state of Paraíba and age, educational level and type of death of women who died of maternal death in the period 2000 to 2004. This cross-sectional study used as a source of data declarations of 109 maternal deaths. Bivariate and multivariate statistical analyses were performed to evaluate the association between variables using multiple logistic regression. The odds ratio to investigate the association between variables was calculated. It was observed that there was no statistical significance between race and age variables or with educational level, but there was significant evidence that nonwhite women from Paraíba were more likely to die from direct obstetric death than white women, (OR = 3.55; IC: 1.20-10.5). The results showed that the risk of maternal mortality in Paraiba was higher among non-white women, revealing an important expression of social inequality.

Recovery of the main causes of death in the Northeast of Brazil: impact on life expectancy

OBJECTIVE To estimate the impact on life expectancy after elimination of the main groups of causes of death in the Brazilian Northeast in 2000. METHODS Data on deaths recorded for the states of Northeastern Brazil in 2000 were extracted from the Mortality Information System. The coverage of death records of children under ten years of age was assessed using indirect procedures. Ledermanns method was used to reclassify the ill-defined death causes, according to sex. Multiple-decrement life tables were constructed for the main groups of causes of death, whose decrement impacts were assessed through life expectancy. RESULTS The total elimination of the main groups of causes in the general mortality resulted in the following gains on the life expectancy of the Northeast for men and women, respectively: infectious and parasitic diseases (1.0 and 0.5 years), malignant neoplasms (1.4 and 1.5 years), circulatory diseases (4.0 and 4.0 years), respiratory diseases (1.1 and 0.8 years), and external causes (2.9 and 0.3 years). CONCLUSIONS The levels of death coverage were found satisfactory, as well as the reclassifications of ill-defined causes for the states. Considering the fact that the vital statistics of the Northeast have not been widely used, due to the argument that their quality limits derivation of reliable mortality indicators, their recovery in a direct way yields consistent results.OBJETIVO: Estimar o impacto na esperanca de vida apos a eliminacao dos principais grupos de causas de morte no Nordeste brasileiro em 2000. METODOS: Dados sobre os obitos registrados para os estados do Nordeste do Brasil em 2000 foram extraidos do Sistema de Informacoes sobre Mortalidade. Foram avaliadas as coberturas dos registros de obitos menores de dez anos usando procedimentos indiretos. Empregou-se o metodo de Ledermann de redistribuicao das causas de morte mal definidas, segundo o sexo. Construiram-se tabuas de vida de multiplo decremento para os principais grupos de causas de morte, cujos impactos dos decrementos foram avaliados pela esperanca de vida. RESULTADOS: A eliminacao total dos principais grupos de causas na mortalidade geral proporcionou para homens e mulheres, respectivamente, os seguintes ganhos na esperanca de vida do Nordeste: doencas infecciosas e parasitarias (1,0 e 0,5 anos), neoplasmas malignos (1,4 e 1,5 anos), doencas do aparelho circulatorio (4,0 e 4,0 anos), doencas do aparelho respiratorio (1,1 e 0,8 anos) e causas externas (2,9 e 0,3 anos). CONCLUSOES: Os niveis das coberturas dos obitos foram aceitaveis, assim como as redistribuicoes das causas mal definidas para os estados. Considerando que as estatisticas vitais do Nordeste sao pouco utilizadas, devido aos argumentos de que sua qualidade limita a producao de indicadores confiaveis da mortalidade, sua recuperacao de forma direta possibilita resultados consistentes.

Mortalidade em Recife: aplicação de um modelo de riscos competitivos

E apresentada a metodologia de Chiang para a construcao de Tabuas de Vida de Multiplo Decremento, aplicadas a populacao residente do municipio de Recife, em 1979, para se avaliar a magnitude de incidencia de alguns grupos de causas de morte, segundo a probabilidade de morte, sobrevivencia e esperanca de vida. A media de vida encontrada para os homens foi de 55,43 anos e para as mulheres foi de 62,41 anos. A eliminacao total dos grupos de causas como fatores de risco de morte, propiciou os seguintes ganhos na esperanca de vida, para homens e mulheres, respectivamente: doencas infecciosas e parasitarias (7,9 e 8,1 anos), neoplasmas malignos (6,0 e 6,6 anos), doencas do aparelho circulatorio (10,4 e 10,8 anos), doencas do aparelho respiratorio (6,5 e 6,7 anos) e causas externas (7,0 e 5,2 anos). Concluiu-se que o nivel de saude do municipio de Recife refletiu, em 1979, um quadro social e economico nao homogeneo, com uma alta mortalidade por doencas degenerativas, caracteristicas de regioes desenvolvidas e, tambem, por doencas infecciosas e parasitarias, proprias de regioes pouco desenvolvidas.