1
|
Kessler M, Thumé E, Marmot M, Macinko J, Facchini LA, Nedel FB, Wachs LS, Volz PM, de Oliveira C. Family Health Strategy, Primary Health Care, and Social Inequalities in Mortality Among Older Adults in Bagé, Southern Brazil. Am J Public Health 2021; 111:927-936. [PMID: 33734851 DOI: 10.2105/ajph.2020.306146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To investigate the role of the Family Health Strategy (FHS) in reducing social inequalities in mortality over a 9-year follow-up period.Methods. We carried out a population-based cohort study of individuals aged 60 years and older from the city of Bagé, Brazil. Of 1593 participants at baseline (2008), 1314 (82.5%) were included in this 9-year follow-up (2017). We assessed type of primary health care (PHC) coverage and other variables at baseline. In 2017, we ascertained 579 deaths through mortality registers. Hazard ratios and their 95% confidence intervals modeled time to death estimated by Cox regression. We also tested the effect modification between PHC and wealth.Results. The FHS had a protective effect on mortality among individuals aged 60 to 64 years, a result not found among those not covered by the FHS. Interaction analysis showed that the FHS modified the effect of wealth on mortality. The FHS protected the poorest from all-cause mortality (hazard ratio [HR] = 0.59; 95% confidence interval [CI] = 0.36, 0.96) and avoidable mortality (HR = 0.46; 95% CI = 0.25, 0.85).Conclusions. FHS coverage reduced social inequalities in mortality among older adults. Our findings highlight the need to guarantee universal health coverage in Brazil by expanding and strengthening the FHS to promote health equity.
Collapse
Affiliation(s)
- Marciane Kessler
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Elaine Thumé
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Michael Marmot
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - James Macinko
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Luiz Augusto Facchini
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Fúlvio Borges Nedel
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Louriele Soares Wachs
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Pâmela Moraes Volz
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Cesar de Oliveira
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| |
Collapse
|
2
|
Soares MU, Facchini LA, Nedel FB, Wachs LS, Kessler M, Thumé E. Social relationships and survival in the older adult cohort. Rev Lat Am Enfermagem 2021; 29:e3395. [PMID: 33439948 PMCID: PMC7798399 DOI: 10.1590/1518-8345.3844.3395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 07/15/2020] [Indexed: 12/04/2022] Open
Abstract
Objective: to verify the influence of social relations on the survival of older adults living in southern Brazil. Method: a cohort study (2008 and 2016/17), conducted with 1,593 individuals aged 60 years old or over, in individual interviews. The outcomes of social relations and survival were verified by Multiple Correspondence Analysis, which guided the proposal of an explanatory matrix for social relations, the analysis of survival by Kaplan-Meier, and the multivariate analysis by Cox regression to verify the association between the independent variables. Results: follow-up was carried out with 82.5% (n=1,314), with 46.1% being followed up in 2016/17 (n=735) and 579 deaths (36.4%). The older adults who went out of their homes daily had a 39% reduction in mortality, and going to parties kept the protective effect of 17% for survival. The lower risk of death for women is modified when the older adults live in households with two or more people, in this case women have an 89% higher risk of death than men. Conclusion: strengthened social relationships play a mediating role in survival. The findings made it possible to verify the importance of going out of the house as a marker of protection for survival.
Collapse
Affiliation(s)
- Mariangela Uhlmann Soares
- Universidade Federal de Pelotas, Pelotas, RS, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | | | - Fúlvio Borges Nedel
- Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Florianópolis, SC, Brazil
| | - Louriele Soares Wachs
- Universidade Federal de Pelotas, Pelotas, RS, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Marciane Kessler
- Universidade Federal de Pelotas, Pelotas, RS, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Elaine Thumé
- Universidade Federal de Pelotas, Pelotas, RS, Brazil
| |
Collapse
|
3
|
Canto VBD, Nedel FB. Completeness of tuberculosis records held on the Notifiable Health Conditions Information System (SINAN) in Santa Catarina, Brazil, 2007-2016. Epidemiol Serv Saude 2020; 29:e2019606. [PMID: 32667455 DOI: 10.5123/s1679-49742020000300020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/11/2020] [Indexed: 11/02/2022] Open
Abstract
Objective to describe the completeness of tuberculosis (TB) case records in Santa Catarina, Brazil, from 2007 to 2016. Methods this was a descriptive study using Notifiable Health Conditions Information System data; completeness, consistency of notification form records and timely notification were analyzed in order to assess data quality. Results completeness of notification form mandatory fields was considered good; essential fields were less complete, in particular the 'Schooling' field; low completeness of follow-up sputum smear microscopy and failure to update culture tests and HIV serology tests demonstrate weaknesses in follow-up records. Conclusion the tuberculosis surveillance system data were considered adequate for guiding tuberculosis prevention and control actions; record monitoring and periodical evaluation, as well as adoption of strategies to improve follow-up report completeness are recommended.
Collapse
Affiliation(s)
- Vanessa Baldez do Canto
- Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Fúlvio Borges Nedel
- Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| |
Collapse
|
4
|
Abstract
This critical commentary extends the debate on social determinants of health and disease. Its main argument is that while further studies are unnecessary to demonstrate the fundamentally social distribution of health outcomes, extant analyses rarely engage with the fact that poverty and other forms of oppression are political choices made by societies, which are both contemporaneously contingent and historically situated. This view must guide research and debate in the area so that studies intending to bring injustice to light do not end up naturalizing it. Research based on this fundamental understanding may help to overcome the narrow scope of multicausal black box approaches, which do not analyze the interrelations among determinants and make only a limited contribution to the construction of healthy societies.
Collapse
Affiliation(s)
- Fúlvio Borges Nedel
- Universidade Federal de Santa Catarina. Departamento de Saúde Pública. Florianópolis, SC, Brasil
| | - João Luiz Bastos
- Universidade Federal de Santa Catarina. Departamento de Saúde Pública. Florianópolis, SC, Brasil
| |
Collapse
|
5
|
Nedel FB. Pacote csapAIH: a Lista Brasileira de Internações por Condições Sensíveis à Atenção Primária no programa R. Epidemiologia e Serviços de Saúde 2019; 28:e2019084. [DOI: 10.5123/s1679-49742019000200021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 04/10/2019] [Indexed: 11/02/2022] Open
|
6
|
Mariano TDSO, Nedel FB. Hospitalization for Ambulatory Care Sensitive Conditions in children under five years old in Santa Catarina State, Brazil, 2012: a descriptive study. Epidemiol Serv Saude 2018; 27:e2017322. [PMID: 30281714 DOI: 10.5123/s1679-49742018000300006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/21/2017] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE to describe proportions and rates of hospitalization for Ambulatory Care Sensitive Conditions (ACSC) among children under 5 years old, in Santa Catarina State, Brazil, 2012. METHODS this is a descriptive study using Brazilian National Health Service Hospital Information System (SIH/SUS) data, classified according to the Brazilian ACSC List. RESULTS a total of 32,445 children aged <5 years old were hospitalized, 25,7% of whom were ACSC cases, representing a rate of 20.1/1,000 inhabitants in the same age group; the main causes were infectious gastroenteritis and complications (26.7%), bacterial pneumonia (22.2%) and pulmonary diseases (16.9%); there was a higher hospitalization rate due to ACSC in males (21.1/1,000), and in children <1 year old (43.8/1,000). CONCLUSION The results showed that the State of Santa Catarina had lower rates and proportions than those found in other Brazilian studies, even though ACSC were the cause of one quarter of hospitalizations in children aged <5 years.
Collapse
Affiliation(s)
| | - Fúlvio Borges Nedel
- Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Departamento de Saúde Pública, Florianópolis, SC, Brasil.,Universitat Autònoma de Barcelona, Unitat de Bioestadística, Grups de Recerca d'Amèrica i Àfrica Llatines, Barcelona, Espanha
| |
Collapse
|
7
|
Nedel FB. [csapAIH: a function to classify ambulatory care sensitive conditions in the statistical software R]. Epidemiol Serv Saude 2017; 26:199-209. [PMID: 28226022 DOI: 10.5123/s1679-49742017000100021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/23/2016] [Indexed: 11/02/2022] Open
Abstract
Hospitalizations due to ambulatory care sensitive conditions (ACSC) are an indirect indicator of primary health care. A package in the R program was developed in order to automatize the classification of codes of the International Statistical Classification of Diseases and Related Health Problems - 10th Revision (ICD-10), according to the Brazilian list of ACSC, and provide functionalities for the management of the "reduced files" of the inpatient hospital authorization (AIH). The csapAIH package contains a homonym function, which reads the data according to its nature (file or data frame with AIH structure, or a factor with ICD-10 codes) and returns, according to defined options, a databank or vector containing the classification for the hospitalization. This article presents the package and the function csapAIH, its installation mode and use, and examples of its functionalities, which may add quickness, precision and validity to the research of ACSC in Brazil.
Collapse
Affiliation(s)
- Fúlvio Borges Nedel
- Universidade Federal de Santa Catarina, Departamento de Saúde Pública, Florianópolis-SC, Brasil.,Universitat Autònoma de Barcelona, Facultat de Medicina, Unitat de Bioestadística, Grups de Recerca d'Amèrica i Àfrica Llatines, Barcelona, Espanha
| |
Collapse
|
8
|
|
9
|
Lima LAD, Nedel FB, Olinto MTA, Baldisserotto J. Food habits of hypertensive and diabetics cared for in a Primary Health Care service in the South of Brazil. REV NUTR 2015. [DOI: 10.1590/1415-52732015000200008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: Describe the eating habits of hypertensive and diabetic individuals, classify their adequacy according to the Ministry of Health's Food Guide for the Brazilian Population and determine the association between adequate diet and the health problems under investigation. METHODS: Descriptive study from the baseline of a longitudinal study begun in 2011, with a sample of hypertensive and diabetic patients from a Primary Health Care facility in Southern Brazil, interviewed at home. RESULTS: A total of 2,482 people were interviewed, of which 66.5% were hypertensive, 6.5% diabetic and 27.1% suffered from hypertension and diabetes. Of those interviewed, 29.6% had inadequate eating habits, 46.9% partially inadequate and 23.4% had adequate diets. Low fiber intake was identified along with high consumption of soda, sugar, salt and saturated fat. The most adequate diet was associated with poor health status and the prevalence of inadequate diet was 30.0% higher among those who were only hypertensive. CONCLUSION: According to Ministry of Health guidelines, the eating habits of diabetic and hypertensive subjects are inadequate. The association between adequate diet and the health problems studied indicated a delayed improvement in diet, suggesting an urgent need for preventive and effective interventions to promote healthy eating.
Collapse
Affiliation(s)
| | | | - Maria Teresa Anselmo Olinto
- Universidade do Vale do Rio dos Sinos, Brasil; Universidade Federal de Ciências da Saúde de Porto Alegre, Brasil
| | | |
Collapse
|
10
|
Abaid RA, Nedel FB, Alcayaga EL. CONDIÇÕES SENSÍVEIS À ATENÇÃO PRIMÁRIA: CONFIABILIDADE DIAGNÓSTICA EM SANTA CRUZ DO SUL, RS. Rev Epidemiol Control Infect 2014. [DOI: 10.17058/reci.v4i3.5045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
11
|
Thier de Borba A, Trevisan Jost R, Gass R, Borges Nedel F, Machado Cardoso D, Hedwig Pohl H, Reckziegel MB, Corbellini VA, Nunes Paiva D. The influence of active and passive smoking on the cardiorespiratory fitness of adults. Multidiscip Respir Med 2014. [DOI: 10.4081/mrm.2014.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: The aim of this study was to analyze the influence of active and passive smoking on cardiorespiratory responses in asymptomatic adults during a sub-maximal-exertion incremental test.
Methods: The participants (n = 43) were divided into three different groups: active smokers (n = 14; aged 36.5 ± 8 years), passive smokers (n = 14; aged 34.6 ± 11.9 years) and non-smokers (n = 15; aged 30 ± 8.1 years). They all answered the Test for Nicotine Dependence and underwent anthropometric evaluation, spirometry and ergospirometry according to the Bruce Treadmill Protocol.
Results: VO2max differed statistically between active and non-smokers groups (p < 0.001) and between non-smokers and passive group (p=0.022). However, there was no difference between the passive and active smokers groups (p=0.053). Negative and significant correlations occurred between VO2max and age (r = − 0.401, p = 0.044), percentage of body fat (r = − 0.429, p = 0.011), and waist circumference (WC) (r = − 0.382, p = 0.025).
Conclusion: VO2max was significantly higher in non-smokers compared to active smokers and passive smokers. However, the VO2max of passive smokers did not differ from active smokers.
Collapse
|
12
|
de Borba AT, Jost RT, Gass R, Nedel FB, Cardoso DM, Pohl HH, Reckziegel MB, Corbellini VA, Paiva DN. The influence of active and passive smoking on the cardiorespiratory fitness of adults. Multidiscip Respir Med 2014; 9:34. [PMID: 25009739 PMCID: PMC4088222 DOI: 10.1186/2049-6958-9-34] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 04/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to analyze the influence of active and passive smoking on cardiorespiratory responses in asymptomatic adults during a sub-maximal-exertion incremental test. METHODS The participants (n = 43) were divided into three different groups: active smokers (n = 14; aged 36.5 ± 8 years), passive smokers (n = 14; aged 34.6 ± 11.9 years) and non-smokers (n = 15; aged 30 ± 8.1 years). They all answered the Test for Nicotine Dependence and underwent anthropometric evaluation, spirometry and ergospirometry according to the Bruce Treadmill Protocol. RESULTS VO2max differed statistically between active and non-smokers groups (p < 0.001) and between non-smokers and passive group (p=0.022). However, there was no difference between the passive and active smokers groups (p=0.053). Negative and significant correlations occurred between VO2max and age (r = - 0.401, p = 0.044), percentage of body fat (r = - 0.429, p = 0.011), and waist circumference (WC) (r = - 0.382, p = 0.025). CONCLUSION VO2max was significantly higher in non-smokers compared to active smokers and passive smokers. However, the VO2max of passive smokers did not differ from active smokers.
Collapse
Affiliation(s)
| | - Renan Trevisan Jost
- Physiotherapy, University of Santa Cruz do Sul (UNISC), Rio Grande do Sul, Brazil
| | - Ricardo Gass
- University of Santa Cruz do Sul (UNISC), Rio Grande do Sul, Brazil
| | - Fúlvio Borges Nedel
- Dsc in Epidemiology, Federal University of Santa Catarina (UFSC), Santa Catarina, Brazil
| | - Dannuey Machado Cardoso
- Physiotherapy, MSc in Medical Science. Assistant Professor, University of Santa Cruz do Sul (UNISC), Rio Grande do Sul, Brazil
| | - Hildegard Hedwig Pohl
- Professional Physical Education. DSc in Regional Development. Titular Professor, University of Santa Cruz do Sul (UNISC), Rio Grande do Sul, Brazil
| | - Miriam Beatris Reckziegel
- Professional Physical Education. MSc in Science of Human Movement, University of Santa Cruz do Sul (UNISC), Rio Grande do Sul, Brazil
| | | | - Dulciane Nunes Paiva
- Physiotherapy, DSc Medical Science, University of Santa Cruz do Sul (UNISC), Rio Grande do Sul, Brazil
| |
Collapse
|
13
|
Reuter ÉM, Reuter CP, Burgos LT, Reckziegel MB, Nedel FB, Albuquerque IMD, Pohl HH, Burgos MS. Obesity and arterial hypertension in schoolchildren from Santa Cruz do Sul--RS, Brazil. Rev Assoc Med Bras (1992) 2013; 58:666-72. [PMID: 23250094 DOI: 10.1590/s0104-42302012000600010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 08/23/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To verify the prevalence of obesity and hypertension in schoolchildren from Santa Cruz do Sul - RS, Brazil, in 2005 and 2008. METHOD The study was performed with two consecutive cross-sectional measurements, consisting of a stratified cluster sample, totaling 414 students, aged between 7 and 17 years, of which 215 (51.9%) were males and 199 (48.1%) were females. Obesity was assessed by body mass index (BMI) and percentage of body fat (%BF). Hypertension was measured by blood pressure values, both systolic (SBP) and diastolic (DBP). RESULTS BMI assessment showed 18.6% and 22.3% of excess weight in males and 22.6% and 14.6% in females (in 2005 and 2008, respectively). Regarding obesity, the prevalence was 4.7% in both years for males and a reduction from 12.6% to 9.0% was observed in females. When analyzing the difference between assessments, there was significance in the BMI classification (p = 0.022) and %BF (p = 0.017) only in females. Statistically significant changes in SBP were found only in males (p < 0.001). CONCLUSION The levels of excess weight, obesity, and %BF in females, as well as the increased levels of systolic blood pressure in males, demonstrate the need for early intervention through more effective public health campaigns.
Collapse
|
14
|
Salinas J, Calvillo S, Caylà J, Nedel FB, Martín M, Navarro A. Delays in the diagnosis of pulmonary tuberculosis in Coahuila, Mexico. Int J Tuberc Lung Dis 2012; 16:1193-8. [PMID: 22747983 DOI: 10.5588/ijtld.11.0476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To determine diagnostic delay in pulmonary tuberculosis (PTB) cases and analyse associated factors. METHODS New PTB cases were studied in Coahuila, Northern Mexico, between 2008 and 2009. We obtained census data and data on residential address, symptoms and diagnosis from the national patient database; sociodemographic variables were obtained during home visits. Bivariate analyses used the Kaplan-Meier method; multivariate analysis consisted of modelling survival. RESULTS We studied 458 subjects (median age 48 years), who were predominantly males (56.1%); the median years of schooling was 6.0 years, 83.4% were urban residents, 50.3% were unemployed, and 87.7% suffered from food poverty. The median delay between the onset of symptoms and the first medical consultation was 53.5 days. Lack of formal education (P = 0.050) and living ≥5 km from a health unit (P = 0.034) were associated with longer delays and consequently with severe symptoms (cough ≥2 weeks, P = 0.001; chest pain, P = 0.032; malnutrition, P = 0.003). Mean health system delay (between first consultation and smear test result) was 18.5 days, and was significantly longer when the first consultation was with a private physician (P < 0.001) and when patient age was ≥46 years (P = 0.001). CONCLUSIONS In Coahuila, lack of formal education, living ≥5 km from a health unit, first consultation with a private physician, and being aged ≥46 years contributed to delays in PTB diagnosis.
Collapse
Affiliation(s)
- J Salinas
- Instituto Mexicano del Seguro Social, Delegación Coahuila, Secretaria de Salud de Coahuila and Grups de Recerca d'America, Saltillo, México
| | | | | | | | | | | |
Collapse
|
15
|
Nedel FB, Facchini LA, Bastos JL, Martín-Mateo M. Conceptual and methodological aspects in the study of hospitalizations for ambulatory care sensitive conditions. Cien Saude Colet 2011; 16 Suppl 1:1145-54. [PMID: 21503462 DOI: 10.1590/s1413-81232011000700046] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 08/07/2009] [Indexed: 11/22/2022] Open
Abstract
Hospitalization rates for Ambulatory Care Sensitive Conditions have been used to assess effectiveness of the first level of health care. From a critical analysis of related concepts, we discuss principles for selecting a list of codes and, taking the example of the Brazilian Family Health Program, propose a methodological pathway for identifying variables in order to inform statistical models of analysis. We argue that for the indicator to be comparable between regions, disease codes should be selected based on sensitivity and specificity principles, not on observed disease frequency. Rates of hospitalization will be determined, at a distal level, by the socio-economic environment and their effect on the social and demographic structure. Timely and effective care depends on the organization of health services, their availability and access barriers, which depend on the ways health and related technology are conceptualised and on their adherence to the biomedical model or to the Primary Health Care (PHC) principles; performance indicators of the health system will be the proximal determinants. This indicator is potentially useful for primary care evaluation. The historical reconstruction of PHC improves the analysis of the indicator variability.
Collapse
Affiliation(s)
- Fúlvio Borges Nedel
- Departamento de Biologia e Farmácia, Curso de Medicina, Programa de Pós-Graduação em Promoção da Saúde, Grupos de Pesquisa em Saúde da América e África Latinas, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS.
| | | | | | | |
Collapse
|
16
|
Nedel FB, Facchini LA, Martín M, Navarro A. Características da atenção básica associadas ao risco de internar por condições sensíveis à atenção primária: revisão sistemática da literatura. Epidemiol Serv Saúde 2010. [DOI: 10.5123/s1679-49742010000100008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
17
|
Nedel FB, Facchini LA, Martín-Mateo M, Vieira LAS, Thumé E. Family Health Program and ambulatory care-sensitive conditions in Southern Brazil. Rev Saude Publica 2009; 42:1041-52. [PMID: 19009161 DOI: 10.1590/s0034-89102008000600010] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Accepted: 05/08/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Ambulatory care-sensitive conditions (ACSC) are health problems managed by actions at the first level of care. The need for hospitalization by these causes is avoidable through an effective and proper primary health care. The objective of the study was to estimate ACSC among patients hospitalized by the Sistema Unico de Saúde (Brazilian Health System). METHODS Hospital-based cross-sectional study involving 1,200 inhabitants of Bagé (Southern Brazil) who were inpatients between September/2006 and January/2007. The patients answered a questionnaire applied by interviewers and were classified according to the model of attention utilized prior to hospitalization. ACSC were defined in a workshop promoted by the Ministry of Health. The variables analyzed included demographic and socioeconomic characteristics, health and health services utilized. Multivariate analysis was conducted by the Poisson model, according to a hierarchical conceptual framework, stratified by sex and model of care. RESULTS ACSC accounted for 42.6% of the hospitalizations. The probability that the main diagnosis for hospitalization is considered an ACSC is greater among women, children under five years of age, individuals with less then five years of schooling, hospitalization in the year prior to the interview, emergency room consultation, and being an inpatient at the university hospital. Among women, ACSC are associated with age, educational level, length of time the health center has been in existence, living in an area covered by the Programa Saúde da Família (Family Health Program), use of this service, emergency room consultation during the month prior to the interview and hospital to which patient was admitted. For men, it was associated with age, have undergone another hospitalization in the year prior to the interview and hospital to which patient was admitted. CONCLUSIONS Analysis of ACSC allows identifying groups with inadequate access to primary health care. Although we could not infer an effect on the risk of hospital admission, analysis by sex and model of care suggests that Family Health Program is more equitable than "traditional" primary health care.
Collapse
Affiliation(s)
- Fúlvio Borges Nedel
- Departamento de Medicina Social, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, RS, Brasil.
| | | | | | | | | |
Collapse
|
18
|
Bastos JLD, Gigante DP, Peres KG, Nedel FB. Determinação social da odontalgia em estudos epidemiológicos: revisão teórica e proposta de um modelo conceitual. Ciênc saúde coletiva 2007; 12:1611-21. [DOI: 10.1590/s1413-81232007000600022] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Accepted: 02/05/2007] [Indexed: 11/21/2022] Open
Abstract
A literatura epidemiológica se caracteriza por limitada abordagem teórica acerca dos mecanismos complexos de determinação das doenças e condições de saúde. No campo da epidemiologia da saúde bucal, isto não tem sido diferente, uma vez que a cárie dentária a doença bucal mais investigada no mundo é comumente vista sob um ponto de vista biologicista/reducionista. Uma das mais importantes conseqüências da cárie é a dor de origem dentária ou odontalgia, a qual tem recebido pouca atenção em investigações com refinamento teórico e delineamento de maior capacidade para inferência causal. O objetivo deste trabalho foi rever a literatura científica sobre os determinantes da odontalgia e colocar em debate teorias pertinentes à explicação do fenômeno. São revistos modelos de determinação e correntes de pensamento emergentes no estudo de morbidades bucais, estabelecendo-se interface com o modelo biopsicossocial da dor e almejando-se a elaboração de um modelo conceitual abrangente da odontalgia. Sugere-se que a ligação entre estrutura social e saúde bucal se dá por meio de vias materiais, comportamentais e psicossociais. Aspectos da estrutura social são levantados na tentativa de relacioná-los com o desfecho de interesse, destacando sua importância nas discussões acerca da causalidade dos fenômenos de saúde bucal.
Collapse
|
19
|
Abstract
INTRODUCTION The register of death by cause, sex and age groups of residents in 1994 in Rio Grande do Sul (RS) and Santa Catarina (SC), two Brazilian southern states, were studied to calculate the years of life lost (YLL), one of the two components that summarize disability adjusted life years (DALY), in RS, SC and Brazil. METHODS The methodology employed is the same used in the Global Burden of Disease study to quantify the mortality component (YLL) of DALY in the world. RESULTS The results show that the greatest proportion and rates caused by Group II (Noncommunicable diseases), linked with more advanced stages of the epidemiological transition, in RS, SC and Brazil. But in both states and especially in Brazil, Group I (Communicable, maternal, perinatal and nutritional conditions) causes an important proportion of YLL. The Group III (Injuries) was the second more important group in RS and SC and the third in Brazil. Road traffic accidents are particularly important in SC, where the intentional injury rate is half than the one in RS. The leading causes of YLL were road traffic accidents, ischemic heart disease and cerebrovascular disease in SC, and ischemic heart disease, cerebrovascular disease and road traffic accidents in RS. CONCLUSIONS Death certification in the southern region of Brazil has a complete coverage and miscoded death proportion is small, providing a reliable mortality information. DALY allow comparing fatal and nonfatal health outcomes to determine the importance of different diseases and to establish health priorities. DALY are also an useful tool to identify disadvantaged groups, target health interventions and provide information for social control of resource allocation.
Collapse
Affiliation(s)
- F B Nedel
- Departamento de Saúde Pública, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil.
| | | | | |
Collapse
|