Wanessa da Silva de Almeida

Pesquisa Nacional de Saude no Brasil: concepcao e metodologia de aplicacao

The National Health Survey is a household-based nationwide survey carried out by the Ministry of Health in partnership with the Brazilian Institute of Geography and Statistics. The scope of the survey is to establish the health status and lifestyles of the population - as well as how they look after their health - with regard to access and use of services, preventive actions, continuity of care, and health care financing. The sample size is 80,000 households and enables the calculation of some indicators at different geographic levels, namely states, capitals, metropolitan and rural areas. The questionnaire is divided into three parts. The first two are answered by one resident and include questions on the household characteristics and on the social and economic level and health status of all inhabitants. The individual questionnaire is answered by an adult (aged 18 years or more), selected with equal probability among the adult residents, and focuses on morbidity and lifestyle. For this individual, measurements of weight, height, waist circumference and blood pressure are taken, as well as laboratory exams to characterize the lipid profile and blood glucose level, as well as determine the urine sodium content. The laboratory exams are taken in a subsample of 25% of the census sectors selected.

Mortalidade infantil e acesso geográfico ao parto nos municípios brasileiros

OBJECTIVE To analyze geographic access to hospital childbirth in Brazilian municipalities. METHODS Information on deaths and births were analyzed in regards to appropriateness for calculating the infant mortality rate during the period 2005 to 2007, for the 5,564 Brazilian municipalities. Indicators of supply and geographic access to health services were calculated to express hospital childbirth access. A multivariate regression model was used to test the association between geographic access to childbirth and the infant mortality rate in municipalities with adequate vital information. RESULTS Of the municipalities analyzed, 56% had adequate vital information, corresponding to 72% of Brazils population. The geographic distance between the municipality of residence and municipality of hospitalization was inversely associated to population size, per capita income and the infant mortality rate, even when controlling for demographic and socioeconomic factors. CONCLUSIONS Although important strategies have been developed in Brazil to improve the quality of care for pregnant women, actions to guarantee equal access to childbirth services are still insufficient. Large geographic distance to childbirth facility was identified as a risk factor for infant mortality, together with unequal supply of quality health services and lack of integration with primary care.OBJETIVO: Analizar el acceso geografico al parto hospitalario en los municipios brasilenos. METODOS: Se analizaron informaciones de obitos y nacimientos con relacion a su adecuacion para el calculo del coeficiente de mortalidad infantil en el periodo de 2005 a 2007 para los 5.564 municipios brasilenos. El acceso geografico fue expresado por indicadores de desplazamiento y oferta y acceso a los servicios de salud. Se evaluo la asociacion entre el acceso geografico al parto y el coeficiente de mortalidad infantil en municipios con adecuacion de sus informaciones vitales por medio de regresion multiple. RESULTADOS: Entre los municipios analizados, 56% presentaron adecuacion de las informaciones vitales, correspondiendo a 72% de la poblacion brasilena. El desplazamiento geografico al parto se evidencio inversamente asociado al porte poblacional y a la renta per capita, y a la mortalidad infantil, aun siendo controlado por factores demograficos y socioeconomicos. CONCLUSIONES: A pesar de que se hayan desarrollado estrategias importantes para el mejoramiento de la calidad de la atencion a las gestantes en Brasil, las acciones para garantizar el acceso igualitario a la asistencia al parto son aun insuficientes. El mayor desplazamiento intermunicipal para el parto se mostro como un factor de riesgo para la mortalidad infantil, aliado a la desigualdad de oferta de servicios calificados y a la falta de integracion con la atencion basica de salud.

Correcao de informacoes vitais: estimacao da mortalidade infantil, Brasil, 2000-2009

OBJECTIVE To propose a simplified method of correcting vital information and estimating the coefficient of infant mortality in Brazil. METHODS Vital data in the information systems on mortality and live births were corrected using correction factors, estimated based on events not reported to the Brazilian Ministry of Health and obtained by active search. This simplified method for correcting vital information for the period 2000-2009 for Brazil and its federal units establishes the level of adequacy of information on deaths and live births by calculating the overall coefficient of mortality standardized by age and the ratio between reported and expected live births, respectively, in each Brazilian municipality. By applying correction factors to the number of deaths and live births reported in each county, the vital statistics were corrected, making it possible to estimate the coefficient of infant mortality. RESULTS The highest correction factors were related to infant deaths, reaching values higher than 7 for municipalities with very precarious mortality information. For deaths and live births, the correction factors exhibit a decreasing gradient as indicators of adequacy of the vital information improve. For the year 2008, the vital information corrected by the simplified method per state were similar to those obtained in the research of active search. Both the birth rate and the infant mortality rate decreased in the period in all Brazilian regions. In the Northeast, the annual rate of decline was 6.0%, the highest in Brazil (4.7%). CONCLUSIONS The active search of deaths and births allowed correction factors to be calculated by level of adequacy of mortality information and live births. The simplified method proposed here allowed vital information to be corrected per state for the period 2000-2009 and the progress of the coefficient of infant mortality in Brazil, its regions and states to be assessed.OBJECTIVE : To propose a simplified method of correcting vital information and estimating the coefficient of infant mortality in Brazil. METHODS : Vital data in the information systems on mortality and live births were corrected using correction factors, estimated based on events not reported to the Brazilian Ministry of Health and obtained by active search. This simplified method for correcting vital information for the period 2000-2009 for Brazil and its federal units establishes the level of adequacy of information on deaths and live births by calculating the overall coefficient of mortality standardized by age and the ratio between reported and expected live births, respectively, in each Brazilian municipality. By applying correction factors to the number of deaths and live births reported in each county, the vital statistics were corrected, making it possible to estimate the coefficient of infant mortality. RESULTS : The highest correction factors were related to infant deaths, reaching values higher than 7 for municipalities with very precarious mortality information. For deaths and live births, the correction factors exhibit a decreasing gradient as indicators of adequacy of the vital information improve. For the year 2008, the vital information corrected by the simplified method per state were similar to those obtained in the research of active search. Both the birth rate and the infant mortality rate decreased in the period in all Brazilian regions. In the Northeast, the annual rate of decline was 6.0%, the highest in Brazil (4.7%). CONCLUSIONS : The active search of deaths and births allowed correction factors to be calculated by level of adequacy of mortality information and live births. The simplified method proposed here allowed vital information to be corrected per state for the period 2000-2009 and the progress of the coefficient of infant mortality in Brazil, its regions and states to be assessed.

Inequalities in healthy life expectancy by Brazilian geographic regions: findings from the National Health Survey, 2013

BackgroundThe demographic shift and epidemiologic transition in Brazil have drawn attention to ways of measuring population health that complement studies of mortality. In this paper, we investigate regional differences in healthy life expectancy based on information from the National Health Survey (PNS), 2013.MethodsIn the survey, a three-stage cluster sampling (census tracts, households and individuals) with stratification of the primary sampling units and random selection in all stages was used to select 60,202 Brazilian adults (18 years and over). Healthy life expectancies (HLE) were estimated by Sullivan’s method according to sex, age and geographic region, using poor self-rated health for defining unhealthy status. Logistic regression models were used to investigate socioeconomic and regional inequalities in poor self-rated health, after controlling by sex and age.ResultsWide disparities by geographic region were found with the worst indicators in the North and Northeast regions, whether considering educational attainment, material deprivation, or health care utilization. Life expectancy at birth for women and men living in the richest regions was 5 years longer than for those living in the less wealthy regions. Modeling the variation across regions for poor self-rated health, statistically significant effects (p < 0.001) were found for the North and Northeast when compared to the Southeast, even after controlling for age, sex, diagnosis of at least one non-communicable chronic disease, and schooling or socioeconomic class. Marked regional inequalities in HLE were found, with the loss of healthy life much higher among residents of the poorest regions, especially among the elderly.ConclusionsBy combining data on self-rated health status and mortality in a single indicator, Healthy Life Expectancy, this study demonstrated the excess burden of poor health experienced by populations in the less wealthy regions of Brazil. To mitigate the effects of social exclusion, the development of strategies at the regional level is essential to provide health care to all persons in need, reduce risk exposures, support prevention policies for adoption of healthy behaviors. Such strategies should prioritize population groups that will experience the greatest impact from such interventions.

Hospitalization of older adults due to ambulatory care sensitive conditions

OBJECTIVE To analyze the temporal evolution of the hospitalization of older adults due to ambulatory care sensitive conditions according to their structure, magnitude and causes. METHODS Cross-sectional study based on data from the Hospital Information System of the Brazilian Unified Health System and from the Primary Care Information System, referring to people aged 60 to 74 years living in the state of Rio de Janeiro, Souhteastern Brazil. The proportion and rate of hospitalizations due to ambulatory care sensitive conditions were calculated, both the global rate and, according to diagnoses, the most prevalent ones. The coverage of the Family Health Strategy and the number of medical consultations attended by older adults in primary care were estimated. To analyze the indicators’ impact on hospitalizations, a linear correlation test was used. RESULTS We found an intense reduction in hospitalizations due to ambulatory care sensitive conditions for all causes and age groups. Heart failure, cerebrovascular diseases and chronic obstructive pulmonary diseases concentrated 50.0% of the hospitalizations. Adults older than 69 years had a higher risk of hospitalization due to one of these causes. We observed a higher risk of hospitalization among men. A negative correlation was found between the hospitalizations and the indicators of access to primary care. CONCLUSIONS Primary healthcare in the state of Rio de Janeiro has been significantly impacting the hospital morbidity of the older population. Studies of hospitalizations due to ambulatory care sensitive conditions can aid the identification of the main causes that are sensitive to the intervention of the health services, in order to indicate which actions are more effective to reduce hospitalizations and to increase the population’s quality of life.

Mortalidade infantil nos municípios brasileiros: uma proposta de método de estimação

Objectives: to propose a method to estimate the Infant Mortality Rate (IMR) by municipality, taking into consideration the underreporting of deaths and the IMR estimation in small population areas Methods: the method was developed on the basis of estimating the correction factors of death and live births by municipality, in the triennium 2009-2011, through indicators that characterize the completeness of vital information. A procedure to test if the corrected number of infant death achieved the expected minimum value was proposed accordingly to the municipality population size. In the case the correction is insufficient the predicted values of a multivariate regression were used to estimate the IMR. Results: the estimation models of the vital information correction factors showed inverse and significant correlations with the completeness indicators. The predicted correction factors were applied to all municipalities located in the states with incomplete vital information. In only 230 municipalities, the correction factors were considered not sufficient. Conclusion: the findings evidence that there are still great problems to surpass, such as the persistent inequalities related to socioeconomic development, access to health care, and omission of death reporting, which compromises the comprehension of a local situation.

Infant mortality and geographic access to childbirth in Brazilian municipalities

OBJECTIVE To analyze geographic access to hospital childbirth in Brazilian municipalities. METHODS Information on deaths and births were analyzed in regards to appropriateness for calculating the infant mortality rate during the period 2005 to 2007, for the 5,564 Brazilian municipalities. Indicators of supply and geographic access to health services were calculated to express hospital childbirth access. A multivariate regression model was used to test the association between geographic access to childbirth and the infant mortality rate in municipalities with adequate vital information. RESULTS Of the municipalities analyzed, 56% had adequate vital information, corresponding to 72% of Brazils population. The geographic distance between the municipality of residence and municipality of hospitalization was inversely associated to population size, per capita income and the infant mortality rate, even when controlling for demographic and socioeconomic factors. CONCLUSIONS Although important strategies have been developed in Brazil to improve the quality of care for pregnant women, actions to guarantee equal access to childbirth services are still insufficient. Large geographic distance to childbirth facility was identified as a risk factor for infant mortality, together with unequal supply of quality health services and lack of integration with primary care.OBJETIVO: Analizar el acceso geografico al parto hospitalario en los municipios brasilenos. METODOS: Se analizaron informaciones de obitos y nacimientos con relacion a su adecuacion para el calculo del coeficiente de mortalidad infantil en el periodo de 2005 a 2007 para los 5.564 municipios brasilenos. El acceso geografico fue expresado por indicadores de desplazamiento y oferta y acceso a los servicios de salud. Se evaluo la asociacion entre el acceso geografico al parto y el coeficiente de mortalidad infantil en municipios con adecuacion de sus informaciones vitales por medio de regresion multiple. RESULTADOS: Entre los municipios analizados, 56% presentaron adecuacion de las informaciones vitales, correspondiendo a 72% de la poblacion brasilena. El desplazamiento geografico al parto se evidencio inversamente asociado al porte poblacional y a la renta per capita, y a la mortalidad infantil, aun siendo controlado por factores demograficos y socioeconomicos. CONCLUSIONES: A pesar de que se hayan desarrollado estrategias importantes para el mejoramiento de la calidad de la atencion a las gestantes en Brasil, las acciones para garantizar el acceso igualitario a la asistencia al parto son aun insuficientes. El mayor desplazamiento intermunicipal para el parto se mostro como un factor de riesgo para la mortalidad infantil, aliado a la desigualdad de oferta de servicios calificados y a la falta de integracion con la atencion basica de salud.

Perception of the Brazilian population on medical health care. Brazil, 2013

The objective was to analyze the perception of the Brazilian population on the medical health care, using data from the National Health Survey, 2013. Among those who have consulted with doctor in the 12 months prior to the survey, we analyzed 12 aspects related to health services and medical consultation, according to type of care (public/ private). By multivariate logistic regression, factors associated with dissatisfaction with the care received were investigated. For the dimensionality reduction of the assessed aspects, we used principal component analysis. The survey revealed that 74.2% of the adult Brazilian population consulted a doctor. Among the differences by type of care, stood out the way of getting an appointment, the type of doctor, the waiting time for service, and the reason for consultation. Median scores were concentrated in 80 (good), except for the waiting time between SUS users. Proportions of very good evaluation were, however, higher among users of the private sector. Despite the positive evaluation in both sectors, public and private, the configuration of the Federative Units in the plane formed by the two principal component axes followed a pattern of striking regional differences.

Consumo abusivo de álcool e envolvimento em acidentes de trânsito na população brasileira, 2013

Abstract This article aims to analyze alcohol abuse and frequent consumption according to sociodemographic characteristics and investigate the risk of greater involvement in traffic accidents, using data from the National Health Survey (PNS), 2013, Brazil. Events investigated were alcohol abuse and frequent consumption and if the individual was involved in a traffic accident and sustained an injury in the last 12 months. We investigated both events according to sociodemographic characteristics and assessed the association among them through multivariate logistic regression. The prevalence of alcohol abuse and frequent consumption was 6.1% for the population aged 18 years and over, 8.9% among men and 3.6% among women. The prevalence of involvement in traffic accidents was 3.1% in the general population and 6.1% among those who reported alcohol abuse. After controlling for sociodemographic factors, alcohol abuse and frequent consumption was significantly associated with traffic accidents. Considering a higher risk of involvement in traffic accidents among individuals who reported alcohol abuse and frequent consumption, monitoring blood alcohol concentration of drivers becomes a strategic possibility of intervention.Abstract This article aims to analyze alcohol abuse and frequent consumption according to sociodemographic characteristics and investigate the risk of greater involvement in traffic accidents, using data from the National Health Survey (PNS), 2013, Brazil. Events investigated were alcohol abuse and frequent consumption and if the individual was involved in a traffic accident and sustained an injury in the last 12 months. We investigated both events according to sociodemographic characteristics and assessed the association among them through multivariate logistic regression. The prevalence of alcohol abuse and frequent consumption was 6.1% for the population aged 18 years and over, 8.9% among men and 3.6% among women. The prevalence of involvement in traffic accidents was 3.1% in the general population and 6.1% among those who reported alcohol abuse. After controlling for sociodemographic factors, alcohol abuse and frequent consumption was significantly associated with traffic accidents. Considering a higher risk of involvement in traffic accidents among individuals who reported alcohol abuse and frequent consumption, monitoring blood alcohol concentration of drivers becomes a strategic possibility of intervention.

Recomendações e práticas dos comportamentos saudáveis entre indivíduos com diagnóstico de hipertensão arterial e diabetes no Brasil: Pesquisa Nacional de Saúde (PNS), 2013

OBJECTIVE To analyze healthy life style recommendations given in health care and the adoption of healthy behaviors among hypertension and diabetes patients. METHODS We analyzed the recommendations according to the place of the last health care visit (primary health care, other public facilities, and private health care facilities). The effects of having a diagnosis of hypertension or diabetes on the adoption of healthy practices were analyzed by multivariate logistic regression models, using sex, age, and educational level as control variables, and the following outcomes: current use of tobacco products; regular physical activity during leisure time; recommended intake of fruits and vegetables; perception of low salt intake; frequent consumption of sweets; and excessive alcohol consumption. RESULTS Approximately 88% of hypertension patients received recommendations to have a healthy diet, 91% to eat less salt, 83% to practice regular physical activity, and 76% to not to smoke. Among diabetic patients, all recommendations related to nutrition were very frequent, reaching 95% for the habit of having fruits and vegetables regularly. The effect of having a diagnosis of hypertension was significant for non-use of tobacco products and perception of low salt intake. The diagnosis of diabetes mainly influenced the habit of not consuming sweets often. CONCLUSION Results evidenced that people with diagnosis of hypertension and diabetes give priority to not use (stop) harmful health behaviors than to adopt practices that will bring benefits to their health. It is necessary to promote not only the adverse effects of harmful habits, but also the benefits of healthy behaviors to aging well.