Rogério Ruscitto do Prado

Mortalidade por doenças crônicas não transmissíveis no Brasil e suas regiões, 2000 a 2011

OBJETIVO:descrever a mortalidade por doencas cronicas nao transmissiveis (DCNT) no periodo 2000-2011 e as projecoes do Plano de Enfrentamento das DCNT no Brasil para 2011-2022.METODOS:estudo descritivo das taxas de mortalidade por doencas do aparelho circulatorio, câncer, diabetes e doencas respiratorias cronicas, com correcoes para causas mal definidas e sub-registro de obitos informados.RESULTADOS:houve um declinio medio de 2,5% ao ano no conjunto das quatro principais DCNT no Brasil; houve declinio em todas as regioes; ocorreram quedas importantes, de 3,3% para doencas cardiovasculares e de 4,4% para doencas respiratorias cronicas, com menores declinios para o câncer, de 0,9%, e para o diabetes, de 1,7%.CONCLUSOES:a reducao de 2% ao ano, ja no primeiro ano do monitoramento, e positiva; espera-se, com a implementacao das acoes previstas no Plano de Enfrentamento das DCNT, e mantida queda como a observada na ultima decada, que o Brasil cumpra a meta proposta.OBJECTIVE: to analyze non-communicable disease (NCDs) mortality trends from 2000 to 2011 and to provide mortality projections for use in evaluating Brazils Plan to Confront Chronic Non-Communicable Diseases, 2011-2022. METHODS: analysis over time of mortality due to cardiovascular diseases, cancer, diabetes and chronic respiratory diseases, with corrections for ill-defined causes and underreporting. RESULTS: the mortality rate attributed to these 4 main NCDs declined 2.5%/year on average, with reductions occurring in all the countrys regions. Decreases were relatively large for cardiovascular diseases (3.3%/year) and for chronic respiratory diseases (4.4%/year), although smaller for cancer (0.9%/year) and diabetes (1.7%/year). CONCLUSIONS: the 2% decrease during the first year of monitoring is positive. The expectation is that when the national Plan actions are implemented, a similar decrease will be maintained, thus enabling the Plans proposed goal to be achieved.

Early identification of leptospirosis-associated pulmonary hemorrhage syndrome by use of a validated prediction model

OBJECTIVE To identify prediction factors for the development of leptospirosis-associated pulmonary hemorrhage syndrome (LPHS). METHODS We conducted a prospective cohort study. The study comprised of 203 patients, aged > or =14 years, admitted with complications of the severe form of leptospirosis at the Emílio Ribas Institute of Infectology (Sao Paulo, Brazil) between 1998 and 2004. Laboratory and demographic data were obtained and the severity of illness score and involvement of the lungs and others organs were determined. Logistic regression was performed to identify independent predictors of LPHS. A prospective validation cohort of 97 subjects with severe form of leptospirosis admitted at the same hospital between 2004 and 2006 was used to independently evaluate the predictive value of the model. RESULTS The overall mortality rate was 7.9%. Multivariate logistic regression revealed that five factors were independently associated with the development of LPHS: serum potassium (mmol/L) (OR = 2.6; 95% CI = 1.1-5.9); serum creatinine (micromol/L) (OR = 1.2; 95% CI = 1.1-1.4); respiratory rate (breaths/min) (OR = 1.1; 95% CI = 1.1-1.2); presenting shock (OR = 69.9; 95% CI = 20.1-236.4), and Glasgow Coma Scale Score (GCS) < 15 (OR = 7.7; 95% CI = 1.3-23.0). We used these findings to calculate the risk of LPHS by the use of a spreadsheet. In the validation cohort, the equation classified correctly 92% of patients (Kappa statistic = 0.80). CONCLUSIONS We developed and validated a multivariate model for predicting LPHS. This tool should prove useful in identifying LPHS patients, allowing earlier management and thereby reducing mortality.

Psychoactive substance use, family context and mental health among Brazilian adolescents, National Adolescent School-based Health Survey (PeNSE 2012)

OBJECTIVE To evaluate the association between the consumption of psychoactive substances (tobacco, alcohol and illicit drugs) and demographic variables, mental health and family context among school-aged children. METHODS The National Adolescent School-based Health Survey was held with a national sample of 109,104 students. Data regarding demographic variables, family background and mental health were collected. Logistic regression was used to evaluate the associations of interest. RESULTS Multivariate analyses showed that alcohol consumption was higher among girls, drug experimentation was more frequent among boys and that there was no difference between sexes for smoking. Being younger and mulatto were negatively associated with the use of tobacco, alcohol and illicit drugs. Also negatively associated with such risk behaviors were characteristics of the family context represented by: living with parents, having meals together and parental supervision (when parents know what the child does in their free time). Moreover, characteristics of mental health such as loneliness and insomnia were positively associated with use of tobacco, alcohol and illicit drugs. Not having friends was positively associated with use of tobacco and illicit drugs and negatively associated with alcohol use. CONCLUSIONS The study shows the protective effect of family supervision in the use of tobacco, alcohol and drugs and, on the contrary, the increasing use of substances according to aspects of mental health, such as loneliness, insomnia and the fact of not having friends. The studys findings may support actions from health and education professionals, as well as from the government and families in order to prevent the use of these substances by adolescents.

Bullying and associated factors among Brazilian adolescents: analysis of the National Adolescent School-based Health Survey (PeNSE 2012)

OBJECTIVE To estimate the prevalence of bullying from the victims perspective in Brazilian school children and to analyze its association with individual and family context variables. METHODS An analysis of the data on 109,104 adolescents, obtained by the National Adolescent School-based Health Survey, held in schools in 2012, was carried out. An association model between bullying and explanatory variables was tested in different contexts: sociodemographic, risk behaviors, mental health and family context. Univariate and multivariate analyzes were performed, calculating the Odds Ratio and confidence intervals. RESULTS The prevalence of bullying found in this study was of 7.2% (95%CI 6.6 - 7.8). A higher chance of bullying was found among male students (OR = 1.58; 95%CI 1.51 - 1.66), with an inverse relation between age and bullying, with the magnitude of risk among adolescents younger than 13 years of age being higher when compared to those with 16 years of age or more. Of individual risk behaviors, only being a smoker remained in the final model (OR = 1.11; 95%CI 1.01 - 1.23). Mental health variables associated with bullying were: feeling lonely (OR = 2.66; 95%CI 2.52 - 2.81), insomnia (OR = 1.92; 95%CI 1.80 - 2.05), not having friends (OR = 1.71; 95%CI 1.54 - 1.89), and, in the family context, those who skip class without telling their parents (OR = 1.13; 95%CI 1,07 - 1,19) and those who suffer physical abuse by family members (OR = 2.03; 95%CI 1.91 - 2.146). CONCLUSION Bullying was associated to male students, younger, of black color, smokers, with mental health vulnerabilities and victims of domestic violence. This suggests the need for a holistic approach from education and health professionals, parents and the community in seeking measures for the prevention of bullying.

Health risks in areas close to urban solid waste landfill sites

OBJECTIVE To evaluate the association between living close to solid waste landfill sites and occurrences of cancer and congenital malformations among populations in their vicinity. METHODS Deaths among people living in the municipality of São Paulo, Southeastern Brazil, between 1998 and 2002 were selected and geocoded, according to selected causes. Over the period evaluated, there were 351 deaths due to liver cancer, 160 due to bladder cancer and 224 due to leukemia, among adults, 25 due to childhood leukemia and 299 due to congenital malformation, in areas close to landfill sites. Buffer zones of radius 2 km around the 15 sites delimited the areas exposed. Standardized mortality ratios for each outcome were analyzed in Bayesian spatial models. RESULTS In a general manner, the highest values for the standardized mortality ratios were found in more central areas of the municipality, while the landfill sites were located in more peripheral areas. The standardized mortality ratios did not indicate any excess risk for people living in areas close to solid waste landfill sites in the municipality of São Paulo. For landfill sites in operation, there was a greater risk of bladder and liver cancer, and death due to congenital malformation, but without statistical significance. CONCLUSIONS No increase in the risk of cancer or congenital malformations was found in areas in the vicinity of urban waste dumps in the municipality of São Paulo. The weak associations and the imprecision of the estimates obtained did not allow any causal relationship to be established.OBJETIVO: Avaliar a associacao entre residencia proxima a aterros de residuos solidos e a ocorrencia de câncer e malformacoes congenitas nessas populacoes vizinhas. METODOS: Foram selecionados e geocodificados obitos ocorridos no periodo de 1998 a 2002 entre residentes do municipio de Sao Paulo, SP, segundo causas selecionadas. No periodo avaliado ocorreram 351 obitos por câncer de figado, 160 de bexiga e 224 por leucemia em adultos, 25 obitos por leucemia entre criancas e 299 por malformacao congenita nas areas proximas aos aterros. Buffers com raios de 2 km em torno de 15 aterros delimitaram as areas expostas. Razoes de mortalidade padronizadas de cada desfecho foram analisadas em modelos espaciais bayesianos. RESULTADOS: De modo geral, os maiores valores das razoes de mortalidade padronizadas localizam-se em areas mais centrais do municipio e os aterros, nas areas mais perifericas. As razoes de mortalidade padronizadas nao indicaram excesso de risco para os residentes nas areas proximas aos aterros de residuos solidos no municipio de Sao Paulo. Para aterros em funcionamento encontrou-se risco aumentado para câncer de bexiga, figado e para mortes por malformacoes congenitas, porem, sem significância estatistica. CONCLUSOES: Nao se encontrou aumento no risco de câncer ou de malformacoes congenitas nas areas vizinhas aos depositos de residuos urbanos do municipio de Sao Paulo. As fracas associacoes e a imprecisao das estimativas obtidas nao permitem estabelecer relacao causal.

Lifetime use of illicit drugs and associated factors among Brazilian schoolchildren, National Adolescent School-based Health Survey (PeNSE 2012)

OBJECTIVE This study aimed at describing the prevalence of illicit drug use among 9th grade students in the morning period of public and private schools in Brazil, and assessing associated factors. METHOD The Brazilian survey PeNSE (National Adolescent School-based Health Survey) 2012 evaluated a representative sample of 9th grade students in the morning period, in Brazil and its five regions. The use of illicit drugs at least once in life was assessed for the most commonly used drugs, such as marijuana, cocaine, crack, solvent-based glue, general ether-based inhalants, ecstasy and oxy. Data were subjected to descriptive analysis, and Pearsons χ² test and logistic regression was used in the multivariate analysis. RESULTS The use of illicit drugs at least once in life was reported by 7.3% (95%CI 5.3 - 9.4) of the respondents. Logistic regression was used for multivariate analysis and the evidences suggest that illicit drug use is associated to social conditions of greater consumption power, the use of alcohol and tobacco, behaviors related to socialization, such as having friends or sexual activity, and also the perception of loneliness, loose contact between school and parents and experiences of abuse in the family environment. The outcome was inversely associated with close contact with parents and parental supervision. CONCLUSION In addition to the association with the processes of socialization and consumption, the influence of family and school is expressed in a particularly protective manner in different records of direct supervision and care.

Validation of the pediatric surgical risk assessment scoring system.

BACKGROUND Within the adult population, there exist numerous validated risk stratification tools aimed at predicting postoperative outcomes using preoperative and intraoperative parameters. However, similar tools for the pediatric population are scarce. We previously developed and reported on a scoring system to predict postoperative complications in children undergoing surgery at Boston Childrens Hospital. The objective of this study was to validate our scoring system to determine its effectiveness in identifying children at risk for major complications or death within 30 days following surgery. STUDY DESIGN A computer program randomly selected 2015 out of 11,734 patients who underwent surgery at our institution in 2009. The severity of the complications was graded based on the Clavien classification system, with major complications being a grade III or higher. The Preoperative Complication Score (PCS) and the Overall Complication Score (OCS) were calculated for all patients, and Receiver Operating Characteristic (ROC) curves were generated for each scoring system. RESULTS The overall incidence of major complications was 3.9% (79 patients). Proportionally, cardiac surgery had the highest percentage of major complications (20% of the performed surgeries). Both PCS and OCS demonstrated excellent correlation with postoperative outcomes with c-statistic values of 0.740 (CI 0.682-0.800, p < 0.001) and 0.767 (CI 0.712-0.822, p < 0.001) respectively. CONCLUSIONS We determined that both the PCS and OCS are effective in identifying children at risk for major complications and death following surgery. Further studies will be needed to determine if these scoring systems are applicable to children undergoing surgery at other institutions and if the use of the scoring systems would result in improved clinical outcomes and reduced costs.

[The aids epidemic in the State of São Paulo: application of the full Bayesian space-time model].

The State of São Paulo accounts for approximately 40% of the AIDS cases notified in Brazil and provides a suitable opportunity for space-time analysis aimed at better understanding of the dissemination of HIV/AIDS. Using the AIDS cases notified to the Ministry of Health between 1990 and 2004, among individuals aged 15 years or over, and the Ministry of Healths information system for disease notification (Sistema de Informação de Agravos e Notificação, SINAN) as the information source, the relative risks of AIDS over three-year periods were estimated using full Bayesian models, for each gender. The models used were shown to be adequate for explaining the process of AIDS dissemination in the State of São Paulo and demonstrated the growth among females and in small-sized municipalities. They also suggested that the municipalities currently most affected are in regions of economic growth and have populations of less than 50,000 inhabitants.

Análise espacial dos riscos à saúde associados à incineração de resíduos sólidos: avaliação preliminar

OBJECTIVES to examine if emissions from the Vergueiro solid waste incinerator are associated with an increased risk of cancer in the population in its vicinity. METHODS the area under influence of this incinerator was delimited by a 7 km radius from its geocoded centroid. Deaths of city residents in administrative districts inside this area due to cancer of lung, liver, larynx, non-Hodgkins lymphoma in adults, leukemia, and all sites combined in children, in the 1998 to 2002 period, were selected and geocoded. The studied area was divided into 7 concentric rings delimited by a radius of 1 to 7 km from the incinerator. The analysis of the relationship between residential proximity to the incinerator and mortality due to cancer was based on the comparison of observed and expected cases, using the Stone test for decline in risk with distance from the incinerator. RESULTS the area studied comprised 1,599,532 inhabitants, of which 92,894 were children less than 5 years old and 634,993 were adults over 40 years old. No spatial gradient in risk was observed for any outcome in relation to distance from the incinerator. CONCLUSION although no excess risk for the selected cancers were observed, emissions of incinerators still operating and their possible health effects should be monitored. The study of the spatial distribution of health events in areas around point sources of air pollution can become a methodological option for surveillance activities.

Chronic non-communicable disease mortality in Brazil and its regions, 2000-2011

OBJETIVO:descrever a mortalidade por doencas cronicas nao transmissiveis (DCNT) no periodo 2000-2011 e as projecoes do Plano de Enfrentamento das DCNT no Brasil para 2011-2022.METODOS:estudo descritivo das taxas de mortalidade por doencas do aparelho circulatorio, câncer, diabetes e doencas respiratorias cronicas, com correcoes para causas mal definidas e sub-registro de obitos informados.RESULTADOS:houve um declinio medio de 2,5% ao ano no conjunto das quatro principais DCNT no Brasil; houve declinio em todas as regioes; ocorreram quedas importantes, de 3,3% para doencas cardiovasculares e de 4,4% para doencas respiratorias cronicas, com menores declinios para o câncer, de 0,9%, e para o diabetes, de 1,7%.CONCLUSOES:a reducao de 2% ao ano, ja no primeiro ano do monitoramento, e positiva; espera-se, com a implementacao das acoes previstas no Plano de Enfrentamento das DCNT, e mantida queda como a observada na ultima decada, que o Brasil cumpra a meta proposta.OBJECTIVE: to analyze non-communicable disease (NCDs) mortality trends from 2000 to 2011 and to provide mortality projections for use in evaluating Brazils Plan to Confront Chronic Non-Communicable Diseases, 2011-2022. METHODS: analysis over time of mortality due to cardiovascular diseases, cancer, diabetes and chronic respiratory diseases, with corrections for ill-defined causes and underreporting. RESULTS: the mortality rate attributed to these 4 main NCDs declined 2.5%/year on average, with reductions occurring in all the countrys regions. Decreases were relatively large for cardiovascular diseases (3.3%/year) and for chronic respiratory diseases (4.4%/year), although smaller for cancer (0.9%/year) and diabetes (1.7%/year). CONCLUSIONS: the 2% decrease during the first year of monitoring is positive. The expectation is that when the national Plan actions are implemented, a similar decrease will be maintained, thus enabling the Plans proposed goal to be achieved.