Recursos humanos em Saúde Pública

The necessity of shorter curricula for preparing human resources for the health sector, better directed towards the true necessities of the population, was pointed out. Low level education personnel should be trained and maintained under supervision; also health "technicians" alike the "feldshers" should be prepared, at senior high school level (undergraduate studies) . The directed formation of a public health professional, without the necessity of a prior degree in dentistry, medicine, nursing or other fields is proposed at the university level.O autor tece considerações sobre a formação de pessoal para a área de saúde, chamando a atenção para a possibilidade de criação de currículos mais curtos, mais voltados para as necessidades das populações. É sugerido o aproveitamento de pessoas informalmente já ligadas ao setor saúde, embora necessitando treinamento e supervisão, tais como "curiosas" e práticos de farmácia. É também proposto o preparo de pessoal de nível médio, um "técnico de saúde", com atuação semelhante ao do "feldsher". No nível universitário, o autor advoga a formação de um profissional específico de saúde pública, independentemente de diploma précio de dentista, médico, enfermeiro ou outro

Regressão linear com duplo truncamento na distribuição da variável dependente

Do problema do ajuste de uma regressão linear, quando a distribuição da variável dependente tem duplo truncamento, utilizando a função de máxima verossimilhança e um processo iterativo.A solution to the problem of fitting a linear regression with double truncation in the distribution of the dependent variable is obtained, using the maximum likelihood function and an iterative process

Uso da técnica de tábua de sobrevivência para estimar sobrevida em casos de câncer

Em estudos epidemiológicos a expressão sobrevida tem sentido bem amplo. Para câncer, por exemplo, sobrevida após o diagnóstico pode ser a quantidade de anos (ou meses, ou dias) que um paciente permanece vivo após um diagnóstico (clínico ou radiológico, ou por biópsia, etc.) de câncer. Mas também se poderia definir sobrevida após alta clínica o tempo para um paciente ter uma recidiva

Reproducibility of information in a study of the risk factors for insulin-dependent diabetes mellitus

The reliability of information about mothers' and fathers' education, weight and height at birth, history of diarrhoea, duration of exclusive breast feeding and age of introduction of cows' milk products, selected from a structured questionnaire used in home interviewers was examined in a sample of 38 cases and 38 controls from a study related to the risk factors of insulin-dependent diabetes mellitus. The repetition of the questions was done by telephone. The agreement between the answers of both interviewers was verified using the kappa statistic (categorical variables) and the intra-class correlation coefficient (quantitative variables). The results enable one to conclude that the information is reproducible.Examina-se, em uma subamostra de 38 casos e 38 controles de um estudo sobre os fatores de risco para o diabetes mellitus insulino-dependente, a reprodutibilidade de informações obtidas para as variáveis escolaridade da mãe e do pai, peso e comprimento da criança ao nascer, história de episódios graves de diarréia, tempo de aleitamento ao seio e idade da introdução de leite de vaca na alimentação infantil, selecionadas a partir do questionário padronizado utilizado em visita domiciliar. A repetição das perguntas foi feita por telefone. A concordância entre as respostas da primeira e segunda entrevista foi verificada mediante a utilização da estatística kappa (variáveis categóricas) e do coeficiente de correlação intraclasse (variáveis quantitativas), para casos e controles separadamente. Os resultados levam a aceitar as informações como reprodutíveis.Universidade Federal de São Paulo (UNIFESP)Universidade de São PauloUNIFESPSciEL

OVERWEIGHT AND ITS RELATIONSHIP WITH DURATION OF BREASTFEEDING IN PRESCHOOLERS

Introduction: obesity is increasing significantly, even in children and adolescents. Breastfeeding has been implicated as a preventive factor of many diseases and in recent years the protective role of breastfeeding against childhood obesity has been observed. Objective: to investigate the prevalence of overweight and its relationship with breastfeeding in children aged 48-60 months. Methods: across-sectional study was conducted involving collection of anthropometric data of children aged 48-60 months from public schools of a city located in Minas Gerais-MG, Brazil, for calculation of body mass index (BMI) and nutritional classification. Data on breastfeeding duration and current feeding were also collected, as well as demographic and socioeconomic variables. Overweight was considered the outcome variable. The main explanatory variable was breastfeeding while the control variables were current feeding and demographic and socioeconomic variables. The relationship between the outcome and explanatory variables was assessed using Poisson regression. Results: the prevalence of overweight children was 9.6%. Exclusive breastfeeding (EBF) for upto 6 months or loger was given to 32.11% of children. The study showed a positive relationship between the presence of EBF and absence of overweight in children aged 48-60 months for the category EBF for 6 months or longer. A similar relationship was not found for complemented breastfeeding. Conclusions: the prevalence of overweight children in the study (9.6%) was higher than the national average (7%). Exclusive breastfeeding for 6 months or longer was associated with absence of overweight and complemented breastfeeding was not associated with children’s weight

Adolescent students’ consumption of fruit, greens and vegetables

Introduction: The intake of fruits, vegetables and greens is in accordance with the recommendations in a minority of the population, especially in adolescents, as it has been shown in literature. The importance to increase this food consumption regards to the prevention of non-transmissible chronic diseases. Objective: was to estimate and describe the frequency of fruit/juice and vegetable intake, and assess the adequacy of this consumption based on the recommendations of the “Ten steps to healthy eating”, in adolescents in Curitiba, Brazil. Methods: The food intake frequency was categorized as adequate or inadequate. The relationship between the intake and the independent variables (socioeconomic) was verified by simple and multiple logistic regressions. Results: The participants were 341 adolescents, most female and aged between 10 - 12 years. The most frequent maternal educational level was High School, most of them working outside home. Monthly family incomes up to 3 minimum wages were most frequent. Most adolescents had inadequate intake of fruits/juices and greens/ vegetables, with higher inadequacy for the latter. Only 3.5% of them had adequate intake of both groups of food. Conclusions: The intake of fruit/juice was not associated with any of the analyzed variables. It was found association of inadequate intake of greens/vegetables only for the age range of 14-19 years, which remained after multiple regression

Decline in cardiovascular disease mortality in the city of S.Paulo, Brazil, 1970 to 1983

Mortality from all causes as well as from the great groups of cardiovascular diseases for the residents of the city of S.Paulo, Brazil, of the ages-group 40-69, for the years 1970 to 1983, has been analysed by means of the specific death rates. During this period a statistically significant decline was observed (28% on the average for ischemic heart diseases and 16% for cerebrovascular diseases). The death rates for the group 40-69 years old for both sexes were age-standardized and compared with those of 27 industrialized countries. The S.Paulo standardized death rates ranked almost always very high in the comparisons.Foi analisada a mortalidade por todas as causas e por grandes grupos de doenças cardiovasculares de residentes da cidade de São Paulo, SP, Brasil, nas idades de 40 a 69 anos, para os anos de 1970 a 1983, mediante os coeficientes específicos de mortalidade. No período observado houve um declínio (28% em média para as doenças isquêmicas do coração e 16% para as doenças cerebrovasculares), estatisticamente significativo. Os coeficientes de mortalidade de 40 a 69 anos, de ambos os sexos, foram ajustados por idade e comparados com os de 27 países industrializados, observando-se alto risco de morrer de doenças cardiovasculares

Food insecurity, mother-child bonding and child malnutrition in a high social vulnerability area

OBJETIVO: analisar a insegurança alimentar e o vínculo inadequado mãe-filho como dois potenciais determinantes da desnutrição em crianças de quatro a seis anos de idade. MÉTODOS: estudo de caso-controle desenvolvido em Escolas Municipais de Educação Infantil (EMEIs) no Jardim Jaqueline, área de alta vulnerabilidade social do município de São Paulo, Brasil. Foram aplicados a Escala Brasileira de Insegurança Alimentar e o Protocolo de Avaliação do Vínculo Mãe-filho, além de coletadas informações biológicas e socio-econômicas. Para verificação dos efeitos de cada variável independente e controle dos efeitos das demais variáveis incluídas no modelo, foi utilizado o modelo de regressão logística múltipla. RESULTADOS: verificou-se que tanto a insegurança alimentar familiar (OR=3,6) como o vínculo inadequado mãe-filho (OR=9,4) estiveram associados com a desnutrição infantil (p<0,05), mesmo após o controle para o peso ao nascimento da criança e idade, estado conjugal e trabalho maternos. CONCLUSÕES: tanto a insegurança alimentar familiar (OR=3,6) como o vínculo mãe-filho inadequado (OR=9,4) mostraram-se fatores determinantes da ocorrência da desnutrição na população estudada.OBJECTIVES: to investigate food insecurity and inadequate bonding between mother and child as two potential factors determining malnutrition among children aged between four and six years. METHODS: a case-control study was conducted in Municipal Primary Schools in Jardim Jaqueline, a highly underprivileged neighborhood of the municipality of São Paulo, Brazil. The Brazilian Food Insecurity Scale and the Mother-Child Bonding Evaluation Protocol were applied and biological and socio-economic data collected. The multiple logistic regression model was used to confirm the effect of each independent variable and to control for other variables included in the model. RESULTS: both family food insecurity (OR=3.6) and inadequate mother-child bonding (OR=9.4) were confirmed to be associated with child malnutrition (p<0.05), even when controlled for weight at birth, age, and marital and employment status of mother. CONCLUSIONS: both family food insecurity (OR=3.6) and inadequate mother-child bonding (OR=9.4) were shown to be factors determining the occurrence of malnutrition in the population covered by the study

Multivariate analysis: an example of the use of a log-linear model

Apresenta-se de forma resumida análise multivariada de dados categóricos, usando modelo log-linear para a situação de uma tabela de contingência 2 x 2 x 2.A multivariate analysis of categorical data using a log-linear model for a 2 x 2 x 2 contingency table is presented