Conceitos e ferramentas da epidemiologia

Esta obra, que faz parte da coleção "Cadernos de Saúde da Família", elaborada pela UNA-SUS/UFMA, é composta por três capítulos, que são: "Epidemiologia e determinantes da saúde", que aborda os diversos campos de atuação da epidemiologia e a influência dos determinantes da saúde no processo saúde-doença; "Indicadores de saúde", que relaciona o uso dos indicadores de saúde com a prática de trabalho do aluno; e "Sistemas de informação em saúde", que discorre sobre alguns sistemas de informação como ferramentas importantes de planejamento das ações de saúde.

Factors associated with prolonged non-nutritive sucking habits in two cohorts of Brazilian children

Abstract Background Non-nutritive sucking habits (NNSH) are very common during childhood. However, if these habits were maintained for 36 months of age or more, they are considered to be prolonged (PNNSH) and can cause occlusal, physiological and esthetic changes. There is controversy about their prevalence and whether perinatal, social, demographic and health characteristics influence their onset and duration. So, the objectives of this study are to estimate the prevalence of PNNSH and to evaluate perinatal, early life and school age factors associated with their occurrence in children. Methods A sample of 1,463 children aged 7–11 years born in Ribeirão Preto (RP-1994) and São Luís (SL-1997/98), Brazil, was reevaluated at school age in 2004/05. Birth weight, gestational age and perinatal variables were obtained at birth. Type of feeding, occurrence and duration of finger and pacifier sucking were recorded retrospectively at school age. PNNSH were defined when persisted for 36 months of age or more. Crude and adjusted prevalence ratios (PR) were estimated by Poisson regression (alpha = 5%). Results Prevalence of PNNSH was higher in RP (47.6%) than in SL (20.2%) – (p < 0.001). Perinatal variables were not associated to PNNSH, whilst female sex (PR = 1.27 in RP; PR = 1.47 in SL) and bottle feeding for 24 months or more (PR = 2.24 in RP; PR = 2.49 in SL) were risk factors in both locations. Breast feeding for 12 months or more (PR = 0.53 in RP; PR = 0.31 in SL) was associated with lower prevalence of PNNSH in both places. In SL, children whose mothers lived in consensual union (PR = 1.62) and worked outside the home (PR = 1.51) showed higher prevalence of PNNSH compared to their counterparts. Conclusions Prevalence of PNNSH was high especially in RP and was not associated with perinatal variables. In both cities there was an association between female sex, shorter breast-feeding duration, longer bottle feeding duration and higher prevalence of PNNSH.http://deepblue.lib.umich.edu/bitstream/2027.42/109521/1/12889_2013_Article_6874.pd

DANOS BUCOMAXILOFACIAIS EM MULHERES: REGISTROS DO INSTITUTO MÉDICO LEGAL DE SÃO LUÍS, MARANHÃO - 2010 A 2013

Introdução: Mulheres vítimas de violência física apontam ser a região de cabeça e pescoço a mais atingida. Objetivo: Caracterizar os casos registrados sobre as mulheres vítimas de violência com lesões bucomaxilofaciais que se submeteram ao Exame deCorpo de Delito no Instituto Médico Legal (IML), no município de São Luís (MA), nos primeiros meses dos anos de 2010 a 2013.Métodos: Foram analisados 1.348 laudos com registros de agressão física com lesões no complexo bucomaxilofacial, sendoanalisadas as seguintes variáveis: mês, ano, faixa etária, raça/etnia, estado civil, situação ocupacional, local de moradia, sexodo agressor, vínculo do agressor com a vítima, tipo de agressão, tipo de instrumento utilizado, tipo de lesão, região bucomaxilofacialacometida e sequelas decorrentes da agressão. Resultados: Dentre as mulheres agredidas 43,8% estavam na faixaetária entre 21-30 anos, a maioria autodeclaradas pardas (75,9%), sem companheiro (71%), empregadas (64,6%) e residentes emSão Luís (MA) (82,6%). Quanto ao agressor, não havia informação em 70,8% dos laudos. Em relação às características da lesão, aequimose foi a mais comum (40,9%) sendo a região orbitária a mais acometida (40,7%). Em praticamente todas as agressõeshouve dano à integridade corporal (99,9%). Conclusão: As vítimas de violência com lesões bucomaxilofaciais são em sua maioriajovens, estão inseridas no mercado de trabalho, a região orbitária foi a mais atingida, sendo as equimoses e as escoriaçõesos tipos de lesões mais comuns.Palavras-chave: Saúde da Mulher. Violência contra a Mulher. Odontologia Legal.AbstractIntroduction: Women victims of physical violence shows the head and neck region hardest hit. Objective: To check the cases towomen victims of violence with maxillofacial injuries who underwent forensic examination at the Medical Legal Institute, in SãoLuís, Maranhão, Brazil, in the first months of the years 2010 to 2013. Methods: A total 1,348 reports with physical aggressionrecords with injuries in the maxillofacial complex were analyzed the following variables: month, year, age, race / ethnicity,marital status, employment status, place of residence, aggressor sex, perpetrator relationship the victim, type of aggression,type of instrument used, type of injury, affected maxillofacial region and consequences resulting from aggression. Results:Among the valid data, 43.8% of battered women were aged 21-30 years, brown (75.9%), unmarried (71%), employed (64.6%)and residents are São Luís, Maranhão, Brazil (82.6%). As the aggressor, there was no information in 70.8% of the reports.Regarding the characteristics of the injury, the bruise was the most common (40.9%) and the orbital region the most affected(40.7%). In almost all attacks there was damage to bodily integrity (99.9%). Conclusion: Victims of violence with maxillofacialinjuries are mostly young, are in the labor market, the orbital region is the most affected in the face, and bruises and abrasionsare the types of most common injury.Keywords: Women's Health. Violence Against Women. Forensic Dentistry

Characteristics of primary care and rates of pediatric hospitalizations in Brazil

OBJECTIVE: To evaluate the association among characteristics of primary health care center (PHCC) with hospitalizations for primary care sensitive conditions (PCSC) in Brazil. METHOD: In this study, a cross-sectional ecological study was performed. This study analyzed the 27 capitals of Brazil’s federative units. Data were aggregated from the following open access databases: National Program for Access and Quality Improvement in Primary Care, the Hospital Information System of Brazilian Unified Health System and Annual Population Census conducted by the Brazilian Institute of Geography and Statistics. Associations were estimated among characteristics of primary care with the number of three PCSC as the leading causes of hospitalization in children under-5 population in Brazil: asthma, diarrhea, and pneumonia. RESULTS: In general, PHCC showed limited structural adequacy (37.3%) for pediatric care in Brazil. The capitals in South and Southeast regions had the best structure whereas the North and Northeast had the worst. Fewer PCSC hospitalizations were significantly associated with PHCC which presented appropriate equipment (RR: 0.98; 95%CI: 0.97–0.99), structural conditions (RR: 0.98; 95%CI: 0.97–0.99), and signage/identification of professionals and facilities (RR: 0.98; 95%CI: 0.97–0.99). Higher PCSC hospitalizations were significantly associated with PHCC with more physicians (RR: 1.23, 95%CI: 1.02–1.48), it forms (RR: 1.01, 95%CI: 1.01–1.02), and more medications (RR: 1.02, 95%CI: 1.01–1.03). CONCLUSION: Infrastructural adequacy of PHCC was associated with less PCSC hospitalizations, while availability medical professional and medications were associated with higher PCSC hospitalizations

The use of dental services in the past year in the brazilian population : a systematic review with meta-analysis

O objetivo foi analisar os fatores asso ciados ao uso dos serviços odontológicos no Bra sil. A estratégia de revisão incluiu as bases Pub Med, SciELO, LILACS, BBO, EMBASE, Scopus, WOS e Google Scholar, além de repositórios e bancos de dissertações e teses. Os estudos foram selecionados usando a estratégia PEO (popula ção/exposição/desfechos). O desfecho deste estudo foi o uso dos serviços odontológicos no último ano pela população brasileira, tratado como variáveis dicotômicas para as análises: ≤ 1 ano e > 1 ano. Foi realizada uma metanálise de efeito randô mico de Mantel-Haenszel, estimando-se razões de prevalência (RP) e intervalos de confiança de 95% (IC95%). Foram selecionados 94 estudos. A maioria (98%) tinha delineamento transversal, sendo 63% oriundos de dados primários. Para a metanálise, 25 estudos foram incluídos. O uso dos serviços odontológicos no último ano esteve associado com maior escolaridade (≥ 8 anos de estudo) (RP = 0,49, (IC95%: 0,39-0,60)); maior renda familiar (≥ 2 salários-mínimos) (RP = 0,79, (IC95%: 0,74-0,84)); e residir na zona urba na (RP = 0,79, (IC95%: 0,64-0,97)). A oferta de serviços odontológicos no Sistema Único de Saú de precisa ser ampliada entre pessoas com menor renda, menor escolaridade e moradores da zona ruralThe scope of this study was to ana lyze the factors associated with the use of dental services in Brazil. The review strategy includ ed PubMed, SciELO, LILACS, BBO, EMBASE, Scopus, WOS and Google Scholar databases, in addition to repositories and databases of disser tations and theses. Studies were selected using the PEO (Population/Exposure/Outcomes) strategy. The outcome of this study was the use of dental services in the last year by the Brazilian popu lation, treated as dichotomous variables for the following analyses: ≤ 1 year and > 1 year. Man tel-Haenszel random effect meta-analysis was performed, estimating Prevalence Ratios (PR) and 95% confidence intervals (95%CI). A total of 94 studies were selected. The majority (98%) had a cross-sectional design, with 63% derived from primary data. For the meta-analysis, 25 studies were included. The use of oral health services in the last year was associated with higher educa tion (≥ 8 years of schooling) (PR = 0.49, (95%CI: 0.39-0.60)); higher family income (≥ 2 minimum wages) (RP = 0.79, (95%CI: 0.74-0.84)); and living in urban areas (RP = 0.79, (95%CI: 0.64- 0.97)). The availability of dental services in the Unified Health System needs to be made readily accessible to people with lower income, less education and those living in rural area

Changes in infant and neonatal mortality and associated factors in eight cohorts from three Brazilian cities

Stillbirth (SBR), perinatal (PMR), neonatal (NMR) and infant mortality rates (IMR) are declining in Brazil and the factors associated with these falls are still being investigated. The objective of the present study was to assess changes in SBR, PMR, NMR and IMR over time and to determine the factors associated with changes in NMR and IMR in eight Brazilian cohorts. All cohorts are population-based (Ribeirão Preto in 1978/79, 1994 and 2010; Pelotas in 1982, 1993 and 2004; and São Luís in 1997/98 and 2010). Were included data on 41440 children. All indicators were decreased, except in the city of Pelotas, from 1993 to 2004, and except SBR in São Luís. Sociodemographic variables seem to be able to explain reductions of NMR and IMR in Ribeirão Preto, from 1978/79 to 1994, and in São Luís. In Ribeirão Preto, from 1994 to 2010 declines in NMR and IMR seem to be explained by reductions in intrauterine growth restriction (IUGR). Newborn’s gestational age had diminished in all cohorts, preventing even greater reductions of NMR and IMR. Improved sociodemographic variables and reduction of IUGR, seem to be able to explain part of the decrease observed. NMR and IMR could have been reduced even more, were it not for the worsening in gestational age distribution

AUTOMEDICAÇÃO EM CRIANÇAS MENORES DE CINCO ANOS NO NORDESTE BRASILEIRO: ESTUDO DE BASE POPULACIONAL

Introdução: Automedicação em crianças é uma prática pouco conhecida no Nordeste do Brasil. Objetivo: Estimar a prevalênciae fatores associados à automedicação em menores de cinco anos. Métodos: Estudo transversal, de base populacional, comamostragem probabilística mínima de 960 crianças, no Maranhão. Foram entrevistadas 1.214 mães em domicílio e a automedicaçãoe as classes de medicamentos foram associadas as variáveis independentes, distribuídas em cinco níveis hierárquicos.Resultados: A automedicação ocorreu em 34,7% das crianças, sendo 10% com antibiótico/psicotrópico. Tiveram maior chancede automedicação filhos de beneficiários (OR= 1,56; IC95%=1,13-2,15), de mães que realizaram menos de cinco consultas prénataisno Sistema Único de Saúde (OR= 1,58; IC95%=1,17-2,14), sem adoecimento três meses antes à pesquisa (OR= 2,05;IC95%=1,45-2,89) e sem plano de saúde (OR= 1,25; IC95%=1,13-2,15). O uso de antibiótico/psicotrópico foi mais frequente emcrianças cujas mães realizaram consultas pré-natais no Sistema Único de Saúde (OR= 0,69; IC95%=0,50-0,95), sem histórico deconsulta médica atual (OR= 0,16; IC95%=0,08-0,33) e sem plano de saúde (OR= 3,78; IC95%=1,45-9,81). Conclusões: A prevalênciade automedicação e o uso de antibióticos e/ou psicotrópicos foi elevada. Tiveram maior chances de automedicação filhosde famílias de menor renda, que receberam benefício social, residentes em área urbana, sem plano de saúde e cujas mães fizeramcinco ou menos consultas pré-natais.Palavras-chave: Automedicação. Antibacterianos. Psicotrópicos. Criança. Sistemas de Saúde