Otaliba Libânio de Morais Neto

Vigilância de Fatores de Risco para Doenças Crônicas por Inquérito Telefônico nas capitais dos 26 estados brasileiros e no Distrito Federal (2006)

OBJETIVO: Descrever metodos e resultados iniciais do Sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas nao Transmissiveis por Inquerito Telefonico - VIGITEL implantado no Brasil em 2006. METODOS: O VIGITEL estudou amostras probabilisticas da populacao com 18 ou mais anos de idade residente em domicilios conectados a rede de telefonia fixa de cada uma das capitais dos 26 Estados brasileiros e do Distrito Federal (54.369 individuos no total, sendo pelo menos 2.000 por cidade). A amostragem foi realizada a partir de cadastros eletronicos completos das linhas residenciais fixas de cada cidade, envolvendo sorteio de linhas (domicilios) e sorteio de um morador por linha para ser entrevistado. O questionario aplicado investigou caracteristicas demograficas e socioeconomicas, padrao de alimentacao e de atividade fisica, consumo de cigarros e de bebidas alcoolicas, e peso e altura recordados, entre outros quesitos. Estimativas sobre a frequencia de fatores de risco selecionados, estratificadas por sexo e acompanhadas de Intervalo de Confianca de 95%, foram calculadas para a populacao adulta de cada cidade empregando-se fatores de ponderacao que igualam a composicao sociodemografica da amostra em cada cidade aquela observada no Censo Demografico de 2000. Estimativas para o conjunto das cidades empregam fator de ponderacao adicional que leva em conta a populacao de adultos de cada cidade. RESULTADOS: Os cinco fatores de risco selecionados (tabagismo, consumo abusivo de bebidas alcoolicas, excesso de peso, consumo de carnes com excesso de gordura e sedentarismo) tenderam a ser mais frequentes em homens do que em mulheres. Dentre os fatores de protecao, o consumo regular de frutas e hortalicas foi mais frequente em mulheres do que em homens, observando-se situacao inversa no caso da atividade fisica de lazer. Diferencas substanciais na frequencia dos fatores de risco e protecao foram observadas entre as cidades, com padroes de distribuicao regional diferenciados por fator. DISCUSSAO: O desempenho do sistema, avaliado a partir da qualidade dos cadastros telefonicos e de taxas de resposta e de recusas, mostrou-se adequado e, de modo geral, superior ao encontrado em sistemas equivalentes existentes em paises desenvolvidos. O custo do sistema de R

Fatores de risco para mortalidade neonatal e pós-neonatal na Regiäo Centro-Oeste do Brasil: linkage entre bancos de dados de nascidos vivos e óbitos infantis

31,15 por entrevista realizada, foi a metade do custo observado no sistema americano de vigilância de fatores de risco para doencas cronicas por inquerito telefonico e um quinto do custo estimado em inquerito domiciliar tradicional realizado recentemente no Brasil.

A Política Nacional de Promoção da Saúde e a agenda da atividade física no contexto do SUS

This article focused on risk factors for neonatal and post-neonatal mortality by linking live births and infant death records. The study was conducted in the municipality of Goiânia, in the Central-West region of Brazil. A total of 20,981 live births and 342 infant deaths constitute the retrospective cohort. Neonatal and post-neonatal mortality risks were estimated in this cohort study of live births by logistic regression. In the neonatal period, the highest ORs were for delivery in public hospitals (OR = 2.28; 95% CI 1.57-3.32), pre-term neonates (OR = 8.94; 95% CI 5.85-13.67), and low birth weight (OR = 8.92; 95% CI 5.77-13.79). Cesarean delivery appeared as a protective factor (OR = 0.58; 95% CI 0.43-0.78). For post-neonatal mortality, the highest ORs were for illiterate mothers (OR = 6.25; 95% CI 1.25-31.27), low birth weight (OR = 3.12; 95% CI 1.67-5.84), and delivery in public hospitals (OR = 2.65; 95% CI 1. 13-6.23). The linkage identified socioeconomic variables that were more important risk factors for post-neonatal than neonatal mortality.This article focused on risk factors for neonatal and post-neonatal mortality by linking live births and infant death records. The study was conducted in the municipality of Goiânia in the Central-West region of Brazil. A total of 20981 live births and 342 infant deaths constitute the retrospective cohort. Neonatal and post-neonatal mortality risks were estimated in this cohort study of live births by logistic regression. In the neonatal period the highest ORs were for delivery in public hospitals (OR = 2.28; 95% CI 1.57-3.32) pre-term neonates (OR = 8.94; 95% CI 5.85-13.67) and low birth weight (OR = 8.92; 95% CI 5.77-13.79). Cesarean delivery appeared as a protective factor (OR = 0.58; 95% CI 0.43-0.78). For post-neonatal mortality the highest ORs were for illiterate mothers (OR = 6.25; 95% CI 1.25-31.27) low birth weight (OR = 3.12; 95% CI 1.67-5.84) and delivery in public hospitals (OR = 2.65; 95% CI 1.13-6.23). The linkage identified socioeconomic variables that were more important risk factors for post-neonatal than neonatal mortality. (authors)O objetivo do presente artigo foi investigar fatores de risco para mortalidade neonatal e pos-neonatal valendo-se do procedimento de linkage de bancos de dados. A coorte foi constituida de 20.981 nascidos vivos em Goiânia, GO, entre os quais ocorreram 342 obitos. Fatores de risco foram estimados utilizando regressao logistica. Para o periodo neonatal, foram encontradas odds ratio (OR) significativas para nascidos em hospital publico-estatal (OR = 2,28; IC 95% 1,57-3,32), prematuro (OR = 8,94; IC 95% 5,85-13,67), baixo peso ao nascer (OR = 8,92; IC 95% 5,77-13,79) e, como fator de protecao, o nascimento por cesariana (OR = 0,58; IC 95% 0,43-0,78). Os subgrupos expostos a um maior risco de mortalidade pos-neonatal foram: nascidos vivos de mae sem instrucao (OR = 6,25; IC 95% 1,25-31,27), baixo peso ao nascer (OR = 3,12; IC 95% 1,67-5,84) e nascimento em hospital publico-estatal (OR = 2,65; IC 95% 1,13-6,23). Os resultados mostram a viabilidade do procedimento para a identificacao de fatores de risco para mortalidade infantil e reafirmam a importância dos fatores socio-economicos como fatores mais relacionados ao componente pos-neonatal da mortalidade infantil.

Inquéritos Nacionais de Saúde: experiência acumulada e proposta para o inquérito de saúde brasileiro

Resumo Este artigo aborda a institucionalizacao da promocao da saude com a aprovacao da Politica Nacional de Promocao da Saude e a escolha da tematica da atividade fisica-praticas corporais como uma de suas prioridades. Sao apresentadas as acoes desenvolvidas pelo Ministerio da Saude na inducao e sustentabilidade de estrategias de reducao do fator de risco do sedentarismo no contexto do Sistema Unico de Saude. Palavras-chave: promocao da saude; atividade fisica; vigilância em Saude Publica; acao intersetorial. Summary This article approaches the institutionalization of health promotion with the approval of the National Policy of Health Promotion, and the election of motor activity-body practices like one of its priorities. It describes the actions developed by the Brazilian Ministry of Health to induce and give sustainability for the strategies of reduction of the risk factor for sedentary lifestyle in the context of the National Health System.

Alcohol-related injuries in emergency departments in Brazil, 2006 and 2007

As informacoes oriundas das fontes de dados secundarios dos sistemas de informacao em saude existentes sao fundamentais, mas insuficientes para responder as necessidades atuais da gestao do Sistema Unico de Saude na identificacao dos problemas e necessidades de saude da populacao brasileira. Os inqueritos populacionais sao instrumentos utilizados como subsidios a formulacao e avaliacao das politicas publicas, tornando-se crescente a sua utilizacao nos diversos paises como ferramenta de apoio ao planejamento em saude. O artigo realiza uma breve revisao das iniciativas de realizacao de inqueritos no âmbito internacional e no Brasil, e propoe um roteiro para a realizacao do Inquerito Nacional de Saude.

Prática de atividade física e sedentarismo em brasileiros: resultados da Pesquisa Nacional por Amostra de Domicílios (PNAD) 2008

Alcohol-related injuries are an important public health issue worldwide. The objective of this study was to describe the epidemiology of alcohol intake perceived by interviewers among injury victims seen at emergency departments in selected Brazilian cities. Cross-sectional data were collected from the injury surveillance system based on sentinel health services recently implemented in the country through intentional sampling in 2006 and 2007 and analyzed in Epi Info 3.5.1. Alcohol intake perception was higher in violence-related injuries than in unintentional injuries (37.9% versus 8%). For violence-related injuries, highest proportions of alcohol intake perception were observed among males (43.7%), 20 to 39 years old (45.3%), blacks (40.5%), and low schooling level victims (40.3%). Settings where these injuries occurred with the highest concerned proportions were taverns (78.2%) and public places (39.5%). Higher alcohol intake perception was observed in assaults (39.1%), suicide attempts (25.4%), transport-related injuries (16.8%), and falls victims (5.9%).

Mortes evitáveis em menores de um ano, Brasil, 1997 a 2006: contribuições para a avaliação de desempenho do Sistema Único de Saúde

Population surveys are a key component of the relevant activities for public health. There is growing interest in identifying behavioral aspects which influence individual and collective health, such as physical activity (PA). The aim of this study is to present PA data from the 2008 Brazilian National Household Survey (PNAD) according to regional distribution and the socio-demographic characteristics. A partnership between the Brazilian Institute of Geography and Statistics and the Ministry of Health was responsible for preparing the health supplement of the questionnaire. The sample size was 292,553 individuals. The proportion of subjects practicing PA at the recommended levels in leisure time was 10.5%, exactly the same proportion of subjects reporting active transportation to and from work. Males and younger adults were more active; schooling was directly related to leisure-time PA and inversely associated with transport-related physical activity. One fifth of the Brazilians did not report any physical activity at all and 35.7% watch TV for 3 hours or more, on average, per day. These data may help design public policies aimed at promoting health, in particular through PA, which may positively influence on the quality of life of the Brazilian population.

Padrão de atividade física em adultos brasileiros: resultados de um inquérito por entrevistas telefônicas, 2006

Infant deaths were classified as avoidable, non-avoidable, and resulting from ill-defined conditions, from 1997 to 2006, using the Brazilian List of Avoidable Causes of Mortality. Non-linear regression was used to calculate trends in cause-specific infant mortality rates. There was a significant decline in both avoidable deaths and deaths from ill-defined causes (p < 0.001). Avoidable deaths decreased by 37% overall. Mortality avoidable through adequate intrapartum care and adequate neonatal care decreased by 27.7% and 42.5%, respectively, while mortality avoidable through adequate prenatal care increased by 28.3%. In conclusion, health services contributed to the reduction in infant mortality. The decrease in ill-defined causes of death indicates expanded access to health services. The increase in access to intrapartum and neonatal care contributed to the reduction in infant deaths. The increase in mortality avoidable through adequate prenatal care indicates the need for improvement in prenatal care.

Population-based surveillance of pediatric pneumonia: use of spatial analysis in an urban area of Central Brazil

Summary This report describes the characteristics of physical activities pattern among adult population of Brazilian State Capitals and the Federal District in 2006. Data was collected through the surveillance system of risk and protection factors for chronic diseases by telephone inquiry (Vigitel) in a probabilistic sample of 54,369 individuals aged 18 years and older. We analyzed two indicators: leisure time physical activity; and sedentariness. The frequency of individuals active in leisure was just of 14.9%, greater among men. Walking is the most common modality for both sex. Frequency of leisure active life increases with education, and decreases with age. Sedentary life affects 29.2% of adult population, more frequently males. The physical activity profile is not satisfactory in all cities, which determines the need for more efforts to stimulate the practice of physical activity.

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

This study examined the spatial distribution of childhood community-acquired pneumonia detected through prospective surveillance in Goiânia, Brazil. Three spatial analysis techniques were applied to detect intra-urban geographic aggregation of pneumonia cases: Kernel method, nearest neighbor hierarchical technique, and spatial scan statistic. A total of 724 pneumonia cases confirmed by chest radiography were identified from May 2000 to August 2001. All cases were geocoded on a digital map. The annual pneumonia risk rate was estimated at 566 cases/100,000 children. Analysis using traditional descriptive epidemiology showed a mosaic distribution of pneumonia rates, while GIS methodologies showed a non-random pattern with hot spots of pneumonia. Cluster analysis by spatial scan statistic identified two high-risk areas for pneumonia occurrence, including one most likely cluster (RR = 2.1; p < 0.01) and one secondary cluster (RR = 1.3; p = 0.01). The data used for the study are in line with recent WHO-led efforts to improve and standardize pediatric pneumonia surveillance in developing countries and show how GIS and spatial analysis can be applied to discriminate target areas of pneumonia for public heath intervention.