Regina Tomie Ivata Bernal

Monitoramento de fatores de risco para doenças crônicas por entrevistas telefônicas

OBJETIVO: Descrever metodos e resultados iniciais de sistema de monitoramento de fatores de risco para doencas cronicas nao transmissiveis por meio de entrevistas telefonicas. METODOS: Estudou-se amostra probabilistica (n=2.122) da populacao adulta do Municipio de Sao Paulo residente em domicilios conectados a rede de telefonia fixa, com amostragem realizada em duas etapas: sorteio de linhas telefonicas e sorteio do morador do domicilio a ser entrevistado. Foi aplicado questionario para investigar caracteristicas demograficas e socioeconomicas, padrao de alimentacao e de atividade fisica, consumo de cigarros e de bebidas alcoolicas, peso e altura recordados e auto-referencia a diagnostico medico de hipertensao arterial e diabetes, entre outros quesitos. Foram calculadas estimativas sobre a prevalencia de fatores de risco selecionados para doencas cronicas nao transmissiveis para a populacao adulta com telefone e para a populacao adulta total do municipio. Neste ultimo caso, populacao total, foram aplicados a amostra fatores de ponderacao que levaram em conta diferencas demograficas e socioeconomicas entre a populacao com telefone e a populacao total do municipio. RESULTADOS: Foram observadas diferencas substanciais entre os sexos quanto a frequencia da maioria dos fatores de risco estudados, sendo significativamente mais frequentes em homens o consumo insuficiente de frutas e hortalicas, o consumo excessivo de bebidas alcoolicas e o excesso de peso; e nas mulheres foram mais frequentes o sedentarismo e a hipertensao. Possibilidades adicionais de estratificacao da prevalencia de fatores de risco permitidas pelo sistema de monitoramento foram ilustradas a partir de exemplos abrangendo faixa etaria, nivel de escolaridade e area de residencia na cidade dos entrevistados. CONCLUSOES: O desempenho do sistema de monitoramento, avaliado a partir da representatividade e confiabilidade das estimativas obtidas e do custo por entrevista realizada, mostrou-se adequado e, de modo geral, superior a sistemas equivalentes existentes em paises desenvolvidos. O custo por entrevista realizada foi oito vezes inferior ao custo estimado por sistemas semelhantes existentes em paises desenvolvidos e quatro a oito vezes inferior ao custo de inqueritos domiciliares tradicionais realizados no Municipio de Sao Paulo.OBJECTIVE To describe methods and initial findings of a surveillance system of risk factors for chronic non-communicable diseases (CNCDs) based on telephone interviews. METHODS Interviews undertaken in a random sample of the adult population of the Municipality of Sao Paulo living in households with telephone. Sampling was done in two steps and included the random selection of households and the random selection of the household member to be interviewed. The systems questionnaire investigated demographic and socioeconomic characteristics, food consumption and physical activity patterns, smoking, consumption of alcoholic beverages, recalled weight and height and reported medical diagnoses of hypertension and diabetes, among other topics. Prevalence estimates of selected risk factors for CNCDs were calculated for the adult population with telephone and for the citys entire adult population. In this last case, we applied sample weighting factors that took into account demographic and socioeconomic differences between the adult population with telephone and the entire adult population of the municipality. RESULTS Strong differences between sexes were found for most risk factors: low consumption of fruit and vegetables, high consumption of alcohol and overweight were more frequent among men while sedentary lifestyle and hypertension were more frequent among women. Additional possibilities of stratification of risk factor prevalences allowed by the surveillance system are illustrated using age groups, schooling, and place of residence in the city. CONCLUSIONS System performance was considered as good and was better than the performance observed in similar systems operating in developed countries when evaluated with basis on the representativeness and reliability of the estimates and on costs. The cost per concluded interview was eight times lower than the cost usually seen in similar systems in developed countries and four to eight times lower than the cost of traditional household surveys undertaken in the city of Sao Paulo.

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

Cobertura de linhas telefônicas residenciais e vícios potenciais em estudos epidemiológicos

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.

Time trends of physical activity in Brazil (2006-2009)

OBJETIVO: Estimar o efeito da taxa de cobertura de linhas telefonicas residenciais em potenciais vicios de informacao em inqueritos epidemiologicos. METODOS: Foram utilizadas as bases de dados da Pesquisa Nacional por Amostra de Domicilios no periodo de 1998 a 2003 para a estimativa das taxas de cobertura de linhas telefonicas residenciais nas cinco regioes geograficas brasileiras. Utilizou-se a regressao logistica multipla para identificar os fatores associados a posse de linha telefonica fixa. O impacto do vicio nos intervalos com 95% de confianca foi avaliado em funcao da precisao alcancada em cada situacao. RESULTADOS: Nas regioes metropolitanas Sudeste, Sul e Centro-Oeste com 70% e mais de cobertura, os vicios associados foram considerados despreziveis. Nas demais regioes, os vicios relativos estavam acima do limite aceitavel (0,4), indicando possiveis erros nas inferencias construidas sob intervalo com 95% de confianca. A chance de acesso a linha telefonica residencial foi maior para populacao com cor da pele branca e maior escolaridade. CONCLUSOES: Os achados mostram que o uso de cadastro de linhas telefonicas residenciais e indicado para a realizacao de inqueritos epidemiologicos apenas para estados com cobertura acima de 70%. Metodologias especificas para o tratamento de estimativas obtidas em localidades com taxas inferiores, precisam ser estudadas e divulgadas.OBJECTIVE To estimate landline telephone coverage effects on potential information bias in epidemiological surveys. METHODS Databases of the Pesquisa Nacional por Amostra de Domicílios (National Household Sample Survey), from 1998 to 2003, were used to estimate landline telephone coverage rates in the five Brazilian geographic regions. Multiple regression analysis was used to identify factors associated with owning a landline telephone. Bias impact on 95% confidence intervals was assessed, according to the accuracy achieved in each situation. RESULTS In the Southern and Central-west metropolitan regions, with 70% coverage or more, associated bias was considered insignificant. In the remaining regions, related bias was above the acceptable limit (0.4), indicating possible errors in inferences drawn with a 95% confidence interval. Likelihood of access to a home landline telephone was greater among the white population with higher level of education. CONCLUSIONS Findings reveal that the use of residential telephone records is indicated to conduct epidemiological surveys in Brazilian states where coverage is above 70% exclusively. Specific methodologies to treat estimates obtained in regions with lower rates need to be analyzed and published.

Trends in prevalence of overweight and obesity in adults in 26 Brazilian state capitals and the Federal District from 2006 to 2012

OBJECTIVE To examine time trends in physical activity (PA) in Brazilian state capitals from 2006 to 2009. METHODS This analysis is based on data from the Telephone-based Surveillance of Risk and Protective Factors for Chronic Diseases (VIGITEL) accounting for an annual sample of approximately 54,000 individuals. PA indicators were analyzed in free time (leisure), work, home and transportation, time spent in front of the television and inactivity considering all PA domains. Poisson regression models were used to measure the variation of indicators over time. We considered the changes corresponding to a regression coefficient different from zero as being statistically significant (p<0.05). RESULTS The percentage of active commuters increased from 11.7 to 14.4% (p<0.001) whereas the proportion of physically inactive individuals in the four domains decreased from 11.7 to 8.7% (p<0.001). There were no significant changes in the other indicators. Women were less active than men in all indicators, except for household chores. However, in this indicator the percentage of active women decreased from 71.4 to 67.1% (p<0.001). Between 2006 and 2009, PA levels in the Brazilian population were stable during free time and household chores, but increased in transportation, resulting in a decrease in the percentage of inactive individuals. CONCLUSION The continued monitoring and strengthening of VIGITEL are public health priorities, and PA is a key part of it. In the long run, PA evolution may be re-evaluated.

Automedicação em adultos de baixa renda no município de São Paulo

OBJECTIVE To describe the annual evolution of the prevalence of overweight and obesity in the adult population of the 26 Brazilian state capitals and the Federal District from 2006 to 2012. METHODS Annual interviews (around 54,000 per year) from VIGITEL (Surveillance System of Risk and Protective Factors for Chronic Non-Communicable Diseases through Telephone Interviews) were used. Self-reported weight and height were used to estimate body mass index and nutritional status. Prevalence estimates of overweight and obesity are presented according to gender, age and schooling and to each city. Linear regression model was used to evaluate the time trend of prevalence. RESULTS Prevalence of overweight in adults in the 27 cities monitored by VIGITEL increased from 43.2% (2006) to 51.0% (2012), with an annual increase rate of 1.37%. Prevalence of obesity increased from 11.6% to 17.4%, with an annual increase rate of 0.89%. The study showed a statistically significant increase in the prevalence of overweight in all cities, and for both genders, all age groups and all levels of schooling. Similar trends were also verified for obesity. CONCLUSIONS If the trends verified from 2006 to 2012 are maintained, in ten years, around two-thirds of the adults in Brazilian state capitals will be overweight, and a quarter will be obese. This perspective requests urgent response from government and intersectoral actions to combat the obesogenic environment.

Causas externas em adolescentes: atendimentos em serviços sentinelas de urgência e emergência nas Capitais Brasileiras - 2009

OBJECTIVE To estimate the self-medication prevalence in low-income adults and identify associated factors. METHODS Data from a population survey performed in São Paulo municipality, Southeastern Brazil in 2005, were used. The sample strategy included two domains, favelas and non-favelas, with clustered sampling performed in two stages with a total of 3,226 eligible individuals. In addition to sociodemographic and economic characteristics, the multiple logistic regression included: use of medicines in the 15 days preceding interview, access to medicines (free, purchased or other) and type of morbidities treated (chronic or acute). RESULTS The proportion of self-medication was 27% to 32%. Self-medication was strongly associated with acute morbidity, ability to purchase medicines, age less than 47 years and the medicine group that acts on the central nervous system. The medicinal group that acts on the central nervous system was the most common utilized in self-medication. CONCLUSIONS Free access to medicines was shown to be a protective factor for self-medication. The distribution of medicines and appropriate health care should be considered when providing patient counseling and for reducing health risks from irrational medicine use.OBJETIVO: Estimar a proporcao de automedicacao em adultos de baixa renda e identificar fatores associados. METODOS: Foram utilizados dados de inquerito populacional realizado no municipio de Sao Paulo em 2005, cujo plano amostral incluiu dois dominios, favela e nao favela, com amostragem por conglomerados em dois estagios, totalizando 3.226 individuos elegiveis. Alem de caracteristicas sociodemograficas e economicas, foram analisados: uso de medicamentos nos 15 dias anteriores a entrevista, tipo de acesso (gratuito, comprado ou outra) aos medicamentos e os tipos de morbidades (cronicas ou agudas) tratadas, em analise de regressao logistica multipla. RESULTADOS: A proporcao de automedicacao foi de 27% a 32%. Automedicacao esteve fortemente associada a morbidade aguda, ao acesso ao medicamento por compra, a idade menor que 47 anos e medicamentos do grupo terapeutico que atuam no sistema nervoso central. O grupo que atua no sistema nervoso central foi o mais utilizado na automedicacao. CONCLUSOES: O acesso gratuito aos medicamentos mostrou-se fator de protecao para a automedicacao. A distribuicao de medicamentos e o atendimento adequado devem ser considerados para orientacao e reducao dos riscos que o uso irracional de medicamentos pode gerar a saude.

Validade e reprodutibilidade de marcadores do consumo de alimentos e bebidas de um inquérito telefônico realizado na cidade de Belo Horizonte (MG), Brasil

Adolescents are seeking new references and experiences, which may involve attitudes of risk and exposure to accidents and violence from external causes. These events constitute a serious Public Health problem. The scope of this study was to analyze the occurrence of accidents by external causes in adolescents from 10 to 19 years of age attended at sentinel urgency and emergency services in Brazil. Data from the 2009 Surveillance System for Violence and Accidents (VIVA 2009) was analyzed in 74 emergency units in 23 state capitals and the Federal District. The findings revealed that 6,434 adolescents (89.8%) were victims of accidents and 730 (10.2 %) were victims of violence. The main causes of the accidents were falls and traffic accidents, and assaults were predominant in violence. For both accidents and violence, non-white male adolescents were predominant and the events occurred most frequently on the public highways. A marked increase was detected, with hospitalization of victims of violence between 15 and 19 years of age. Understanding the epidemiological reality of external causes among adolescents represents an important tool for health prevention and promotion policies and the culture of peace seeking to reduce morbidity and mortality.

Análise das ocorrências das lesões no trânsito e fatores relacionados segundo resultados da Pesquisa Nacional por Amostra de Domicílios (PNAD) Brasil, 2008

OBJECTIVE To evaluate the validity and reproducibility markers of food and beverage intake obtained by means of a telephone-based surveillance system. METHODS Reproducibility was assessed by means of repeated interviews with a 7-15 day interval after the first interview of the system (n=258). Validity was analyzed based on three interviews corresponding to the 24 hour recall method, used as gold standard, 3 days a week, 7 to 15 days after the original telephone interview (n=217). In the study of reproducibility, kappa statistics was used to measure the similarity between the results of the proportions obtained in the first and second interviews. For validation, the proportion of positive reports regarding foods and beverages at the original telephone interview was compared to that obtained by the 24 hour recall method, and the results was analyzed by calculating sensitivity, specificity and positive predictive value. RESULTS In the reproducibility study, the agreement was almost perfect for the marker milk consumption (0.86), substantial for fruit consumption (0.67), intake of fruits and vegetables, intake of meat with fat and alcohol abuse. The agreement was moderate for the intake of soft drink, and fair for the consumption of vegetables. Regarding the validity, there was an underestimation of fruit, vegetable and milk consumption, except for meat and alcohol when compared with the consumption frequency estimated from the three 24-hours recalls, differences related to soft drink consumption was inexpressive. CONCLUSION The instruments enabled the surveillance of factors which were potentially associated with chronic diseases, however, it is a priority to continue with validation studies in other populations to provide greater system reliability, always considering possible limiting factors.OBJETIVO: avaliar a reprodutibilidade e validade de indicadores de consumo de alimentos e bebidas levantados por meio de entrevistas telefonicas pelo Sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas por Telefone (VIGITEL). METODOS: A reprodutibilidade foi aferida por meio de entrevistas repetidas com intervalos de 7 a 15 dias a partir da primeira entrevista original do sistema (n=258). A validade foi avaliada usando como padrao ouro 3 entrevistas correspondentes a recordatorios de 24h (R24h) em 3 dias da semana, apos 7 a 15 dias da entrevista telefonica original (n=217). No estudo de reprodutibilidade a estatistica kappa foi utilizada para medir a concordância entre os resultados das proporcoes obtidas na primeira e na segunda entrevista. Para a validacao, a proporcao de referencia positiva de alimentos e bebidas na entrevista telefonica original foi comparada aquela obtida nos R24h e sua avaliacao foi analisada por meio do calculo da sensibilidade, especificidade e valor preditivo positivo. RESULTADOS: No estudo de reprodutibilidade, observou-se concordância quase perfeita para o indicador de consumo de leite com teor integral de gordura (0,86); concordância substancial para consumo de frutas (0,67), consumo de frutas e hortalicas, consumo de carne com gordura ou frango com pele e consumo abusivo de bebida alcoolica; concordância moderada para o indicador de consumo de refrigerante; e concordância regular para o indicador do consumo de hortalicas. Com relacao ao estudo de validacao, observou-se subestimacao de indicadores de consumo de frutas, hortalicas e leite integral, exceto para consumo de carne/frango com gordura e bebida alcoolica, quando comparados com a frequencia desse consumo estimada a partir dos tres R24horas; as diferencas para o consumo de refrigerantes foi inexpressiva. CONCLUSAO: Verificou-se que os instrumentos utilizados permitem a vigilância de fatores potencialmente associados a doencas nao transmissiveis, entretanto, e prioritaria a continuidade de estudos de validacao em outras populacoes do sistema, com o objetivo de oferecer maior confiabilidade aos mesmos, sempre considerando as potenciais limitacoes.

Self-medication in low-income adults in Southeastern Brazil

The study describes the estimates of occurrence of injury due to traffic accidents among the Brazilian population based on data obtained from the National Household Sample Survey (PNAD). It is a probabilistic sample, in which 391,868 people were interviewed. in three stages, namely municipalities, census sectors and households. The traffic accident (TA) and the safety belt usage variables were described according to socio-demographic variables and region of residence. Proportions, 95% confidence intervals, c2 tests and p values were calculated. 2.5% (CI95% 2.4-2.6%) of the population reported higher traffic accident (TA) incidence among males (3.5%; CI95%: 3.4-3.6), youths (4.4%; CI95%: 4.2-4.6) and residents in the Central-West region (3.3% CI95%3.0-3.6). Most of the events involved drivers or passengers of cars or vans (53.9%), followed by motorcyclists or pillion passengers (30.1%), cyclists (7.6%) and pedestrians (5.25%). The front seat safety belt is used by 73.2% (CI95% 72.2-74.2) and the rear seat safety belt is only used by 37.4% (CI95% 36.6-38.2). Traffic accidents led to the abandonment of their habitual activities by 30.7% of those involved. The severity of injuries in traffic accidents demands further preventive and legislative measures to reduce such incidents.