Ultrasound as a method to evaluate the distribution of abdominal fat in obese prepubertal children and the relationship between abdominal fat and metabolic alterations.

Abstract. OBJECTIVE: To evaluate, using ultrasound, the distribution of abdominal fat in obese prepubertal children, as well as its possible correlation with metabolic changes due to obesity. MATERIALS AND METHODS: This was a cross-sectional study of prepubescent children: 77 obese children (33 girls and 44 boys), with a mean age of 7.31 years; and 31 normal-weight children (17 girls and 14 boys), with a mean age of 7.32 years. In all of the children, abdominal wall thickness (AWT) and abdominal fat thickness (AFT) were measured by ultrasound. For the evaluation of the associated metabolic alterations, serum levels of glycemia, HDL cholesterol, triglycerides, and insulin were determined. RESULTS: The obese children presented with greater abdominal fat, predominantly greater AWT, without a significant gender-related difference in AWT or AFT. The homeostasis model assessment of insulin resistance (HOMA-IR) showed a significant direct correlation with AWT and AFT. CONCLUSION: In obese prepubertal children, the AWT, as measured by ultrasound, was shown to be more closely related to the HOMA-IR than to the lipid metabolism or glycemia.

OBJETIVO: Avaliar, em crianças pré-púberes obesas, a distribuição da gordura no abdome por meio da ultrassonografia e sua possível correlação com as alterações metabólicas decorrentes da obesidade. MATERIAIS E MÉTODOS: Estudo transversal em crianças pré-púberes, sendo 77 obesas (33 meninas e 44 meninos) com média de idade de 7,31 anos e 31 eutróficas (17 meninas e 14 meninos) com média de idade de 7,32 anos. Em todas as crianças foram medidas a espessura da parede abdominal (EPA) e a espessura da gordura intra-abdominal (EIA), pela ultrassonografia. Para a avaliação das alterações metabólicas associadas, foi realizada dosagem sérica de glicemia, HDL-colesterol, triglicerídeos e insulina. RESULTADOS: Observou-se que as crianças obesas apresentaram aumento da gordura abdominal, com predomínio da EPA e sem diferença significativa da EIA e a EPA em relação ao gênero. Foi encontrada associação direta estatisticamente significante entre o índice homeostatic model assessment for insulin resistance (HOMA-IR) e EPA e EIA. CONCLUSÃO: A EPA em pré-púberes obesos, medida pela ultrassonografia, demonstrou ter maior relação com o HOMA-IR, determinante de resistência insulínica, em relação ao metabolismo lipídico e à glicemia.

Ultrasound as a method to evaluate the distribution of abdominal fat in obese prepubertal children and the relationship between abdominal fat and metabolic alterations / A ultrassonografia como método de avaliação da distribuição da gordura abdominal em crianças pré-púberes obesas e sua relação com alterações metabólicas

Abstract Objective: To evaluate, using ultrasound, the distribution of abdominal fat in obese prepubertal children, as well as its possible correlation with metabolic changes due to obesity. Materials and Methods: This was a cross-sectional study of prepubescent children: 77 obese children (33 girls and 44 boys), with a mean age of 7.31 years; and 31 normal-weight children (17 girls and 14 boys), with a mean age of 7.32 years. In all of the children, abdominal wall thickness (AWT) and abdominal fat thickness (AFT) were measured by ultrasound. For the evaluation of the associated metabolic alterations, serum levels of glycemia, HDL cholesterol, triglycerides, and insulin were determined. Results: The obese children presented with greater abdominal fat, predominantly greater AWT, without a significant gender-related difference in AWT or AFT. The homeostasis model assessment of insulin resistance (HOMA-IR) showed a significant direct correlation with AWT and AFT. Conclusion: In obese prepubertal children, the AWT, as measured by ultrasound, was shown to be more closely related to the HOMA-IR than to the lipid metabolism or glycemia.

Resumo Objetivo: Avaliar, em crianças pré-púberes obesas, a distribuição da gordura no abdome por meio da ultrassonografia e sua possível correlação com as alterações metabólicas decorrentes da obesidade. Materiais e Métodos: Estudo transversal em crianças pré-púberes, sendo 77 obesas (33 meninas e 44 meninos) com média de idade de 7,31 anos e 31 eutróficas (17 meninas e 14 meninos) com média de idade de 7,32 anos. Em todas as crianças foram medidas a espessura da parede abdominal (EPA) e a espessura da gordura intra-abdominal (EIA), pela ultrassonografia. Para a avaliação das alterações metabólicas associadas, foi realizada dosagem sérica de glicemia, HDL-colesterol, triglicerídeos e insulina. Resultados: Observou-se que as crianças obesas apresentaram aumento da gordura abdominal, com predomínio da EPA e sem diferença significativa da EIA e a EPA em relação ao gênero. Foi encontrada associação direta estatisticamente significante entre o índice homeostatic model assessment for insulin resistance (HOMA-IR) e EPA e EIA. Conclusão: A EPA em pré-púberes obesos, medida pela ultrassonografia, demonstrou ter maior relação com o HOMA-IR, determinante de resistência insulínica, em relação ao metabolismo lipídico e à glicemia.

Risk of urinary retention after nerve-sparing surgery for deep infiltrating endometriosis: A systematic review and meta-analysis.

AIMS: Recently, nerve-sparing (NS) techniques have been incorporated in surgeries for deep infiltrating endometriosis (DIE) to prevent urinary complications. Our aim was to perform a systematic review and meta-analysis to assess the risk of urinary retention after NS surgery for DIE compared with classical (non-NS) techniques. METHODS: Following the MOOSE guidelines for systematic reviews of observational studies, data were collected from published research articles that compared NS techniques with non-NS techniques in DIE surgery, with regard to post-operative urinary complications. INCLUSION CRITERIA: randomized clinical trials, intervention or observational (cohort and case-control) studies assessing women who underwent surgery for painful DIE. EXCLUSION CRITERIA: cancer surgery and women submitted to bladder or ureteral resections. The respective relative risks (RR) and 95% confidence intervals (CI) were extracted and a forest plot was generated to show individual and combined estimates. RESULTS: Preliminarily, 1,270 potentially relevant studies were identified from which four studies were selected. A meta-analysis was performed to assess the risk of urinary retention at discharge and 90 days after surgery. We found a common RR of 0.19 [95%CI: 0.03-1.17; (I2 = 50.20%; P = 0.09)] for need of self-catheterization at discharge in the NS group in relation to the conventional technique. Based on two studies, common RR for persistent urinary retention (after 90 days) was 0.16 [95%CI: 0.03-0.84]. CONCLUSIONS: Our results suggest significant advantages of the NS technique when considering the RR of persistent urinary retention. Controlled studies evaluating the best approach to manage the urinary tract after complex surgery for DIE are needed. Neurourol. Urodynam. 36:57-61, 2017. © 2015 Wiley Periodicals, Inc.

Convergence of Health Level Seven Version 2 Messages to Semantic Web Technologies for Software-Intensive Systems in Telemedicine Trauma Care.

OBJECTIVES: To present the technical background and the development of a procedure that enriches the semantics of Health Level Seven version 2 (HL7v2) messages for software-intensive systems in telemedicine trauma care. METHODS: This study followed a multilevel model-driven approach for the development of semantically interoperable health information systems. The Pre-Hospital Trauma Life Support (PHTLS) ABCDE protocol was adopted as the use case. A prototype application embedded the semantics into an HL7v2 message as an eXtensible Markup Language (XML) file, which was validated against an XML schema that defines constraints on a common reference model. This message was exchanged with a second prototype application, developed on the Mirth middleware, which was also used to parse and validate both the original and the hybrid messages. RESULTS: Both versions of the data instance (one pure XML, one embedded in the HL7v2 message) were equally validated and the RDF-based semantics recovered by the receiving side of the prototype from the shared XML schema. CONCLUSIONS: This study demonstrated the semantic enrichment of HL7v2 messages for intensive-software telemedicine systems for trauma care, by validating components of extracts generated in various computing environments. The adoption of the method proposed in this study ensures the compliance of the HL7v2 standard in Semantic Web technologies.

Association of cytokine gene polymorphisms with hepatitis C virus infection in a population from Rio de Janeiro, Brazil.

BACKGROUND: The host immune response is an important indicator of the outcome of hepatitis C virus (HCV) infection and disease progression. The aim of this study was to explore cytokine gene polymorphisms as a candidate for susceptibility to persistent HCV infection or HCV spontaneous clearance in a population from Rio de Janeiro, Brazil. METHODS: Genetic polymorphisms in the cytokines, tumor necrosis factor-alpha (-308), transforming growth factor-beta 1 (codons 10 and 25), interleukin-10 (IL-10; -1082 and -592), IL-6 (-174), and interferon-gamma (+874) were analyzed by polymerase chain reaction sequence-specific primers in 245 patients with chronic hepatitis C (CHC), 41 spontaneous recovery (SR) patients, and 189 healthy volunteers. Further, polymorphisms in IL-28B (rs12979860, rs12980275, and rs8099917) were assessed by real-time polymerase chain reaction in all groups. RESULTS: The IL-28B rs12979860 CC and rs12980275 AA genotypes were significantly associated with SR of HCV infection and response to therapy, whereas the C allele of IL-6 (-174) was associated with protection to CHC. A multivariate analysis showed that the male sex and IL-28B rs12979860 CT and TT and transforming growth factor-beta 1 (codon 10) TC genotypes were factors associated with CHC. Additionally, IL-6 (-174) C allele was increased in SR patients compared with patients with CHC. CONCLUSION: IL-28B polymorphisms are associated with spontaneous clearance of HCV and response to therapy in a Brazilian population. Also, IL-6 (-174) C allele is involved in SR and decreased inflammation scores.

Modelagem da Ficha de Notificação de Violência no modelo openEHR / Modeling of Violence Notification Form in the openEHR model / Modelado Del Formulario de Notificación de Violencia en modelo openEHR

Segundo a OMS, a violência contra crianças e adolescentes se tornou um problema de saúde pública. Na garantia dos direitos destes, os profissionais de saúde, apesar de responsabilizados pelo SUS pela notificação compulsória de suspeita de maus tratos, nem sempre o fazem. Selecionamos a Ficha de Notificação de Violência para modelagem dos conceitos a serem incluídos num sistema computadorizado de detecção de violência contra crianças e adolescentes. Os termos associados à violência foram utilizados para busca no repositório global de arquétipos da Fundação openEHR. Este mapeamento resultou em 27 correspondências com 57 elementos, e para os termos não encontrados, foi criado um arquétipo. O padrão utilizado é baseado na modelagem multinível de sistemas de informação em saúde e tem por objetivo auxiliar futuramente no diagnóstico auxiliado por computador e fornecer uma informação em rede para identificação de casos, intervindo a tempo na proteção a estas violências...

According to WHO, violence against children and adolescents has become a public health problem. For ensuring the rights of them, healthcare professionals, although responsible in SUS for reporting suspected abuse, do not always do so. We selected the Violence Reporting Form to modeling concepts to be included in a computerized detection of violence against children. The terms that were associated with violence were searched on the global archetype repository of the openEHR Foundation. This mapping found 27 matches among 57 elements, and for the terms that were not found an archetype was created. This standard is based on multilevel modeling of health information systems and aims to help in future computer-aided diagnosis and to provide a networked information to identify cases, intervening in time to protect this type of violence...

Según la OMS, la violencia contra los niños y adolescentes se ha convertido em un problema de salud pública. Para garantizar sus derechos, profesionales de la salud, aunque responsables por el SUS, por informar sospecha de abuso, no siempre lo hacen. Seleccione el Registro de Notificación de la Violencia para el modelado de los conceptos que se incluirán en una detección automatizada de la violencia contra los niños. Los términos relacionados con la violencia se buscaron en el almacén global de arquetipos de la Fundación openEHR. Este mapeo encontró 27 coincidencias entre 57 elementos y para los términos que no se encontró, creó un arquetipo. El estándar utilizado se basa en el modelado multinivel de los sistemas de información de salud y tiene como objetivo ayudar en uno futuro diagnóstico asistido por computadora y proporcionar la información en red para identificar los casos, interviniendo a tiempo para prevenir estas violencias...

Perfil da assistência em um hospital universitário: informações do registro hospitalar de câncer, 2000-2009 / Cancer care profile at a university hospital: information from the hospital-based cancer registry, 2000-2009

Introdução: As bases de dados do Registro Hospitalar de Câncer permitem a elaboração de atividades relacionadas à vigilância e planejamento de atenção à saúde. Objetivo: Analisar a base de dados do Registro Hospitalar de Câncer do Hospital Universitário Antônio Pedro, da Universidade Federal Fluminense, no período de 2000-2009, segundo sexo, faixa etária, localização do tumor primário e mortalidade intra-hospitalar. Método: Exportação da base de dados e elaboração de tabelas de análise bivariada, com estimativa de testes de hipóteses e medidas de associação. Resultados: Foram registrados 3.544 pacientes, sendo 55,3 por cento do sexo feminino. Do total de casos, para o sexo masculino, houve maior concentração na faixa etária de 60 a 79 anos (51,0 por cento); enquanto, no sexo feminino, predominou a faixa etária de 40 a 59 anos (45,8 por cento). No sexo masculino, os tumores mais frequentemente atendidos no serviço foram: aparelho digestivo (29,2 por cento), seguidos por aparelho genital (19,9 por cento) e aparelho respiratório (19,3 por cento). No sexo feminino, os tumores da mama foram os mais registrados (37,8 por cento), seguidos por aparelho digestivo (17,4 por cento) e aparelho genital (13,4 por cento). A mortalidade intra-hospitalar foi maior no sexo masculino (13,2 por cento) do que no feminino (10,2 por cento), perfazendo uma razão de mortalidade entre os sexos de 1,30, estatisticamente significativa. Conclusão: Este trabalho visou a contribuircom a atuação do Hospital Universitário Antônio Pedro, assim como da rede hospitalar pública no país, na área da assistência oncológica.

Analysis of the medicine sales on the Internet: the case of thephosphodiesterase-5 inhibitors

Context: The e-commerce of medications is one of the most recent expressions of irrational drug use, as part of the ?medicalization of the society? process. Medicines with high marketing appeal, such as the 5-phosphodiesterase inhibitors (5PDEI), represent the extreme cases of this contemporary public health problem. Objective: The objective of this study was to analyze the features of legal and illegal 5PDEI e-commerce websites in Portuguese language, according to the Brazilian medicine marketing regulation benchmark. Methods: Websites containing advertisements of legal and illegal presentations of 5PDEI were searched using the Google? search engine. Data regarding adherence to the ANVISA recommendations were collected and statistical analysis was performed to compare the variables between legal and illegal presentation advertisements. Results: The study found 497 advertisements, 310 legal and 187 illegal. Both types of sites showed few differences regarding the analyzed variables, as well as low adherence to the ANVISA recommendations. Conclusion: This study shows that the regulation of medicines e-commerce in Brazil is incipient. Thus, beyond the regulation benchmark, more general public health interventions are important and needed.

Contexto: O comércio eletrônico de medicamentos é uma das mais recentes expressões do uso irracional de medicamentos, como parte do processo de ?medicalização da sociedade?. Medicamentos com alto apelo mercadológico, tais como os inibidores da 5-fosfodiesterase (I5FDE), representam casos extremos deste problema de saúde contemporâneo. Objetivo: O objetivo deste estudo foi analisar as características de endereços eletrônicos para I5FDE legais e ilegais em português, de acordo com o marco regulatório do mercado de medicamentos brasileiro. Métodos: Endereços eletrônicos contendo anúncios de venda de apresentações legais e ilegais de I5FDE foram buscados pelo uso da ferramenta de busca Google?. Os dados relativos à adesão às recomendações da ANVISA foram coletados e uma análise foi realizada de modo a comparar as variáveis presentes nas propagandas das apresentações legais e ilegais. Resultados: o estudo encontrou 497 anúncios, 310 legais e 187 ilegais. Ambos os tipos de endereços eletrônicos apresentaram poucas diferenças referentes às variáveis analisadas, assim como baixa adesão às recomendações da ANVISA. Conclusão: Este estudo demonstra que a regulação do comércio eletrônico de medicamentos no Brasil é incipiente. Assim, para além do marco regulatório, intervenções de caráter mais genérico em saúde pública são importantes e necessárias.

Analysis of prehospital care for stroke and acute myocardial infarction in the elderly population of Minas Gerais, Brazil.

OBJECTIVE: To analyze the association between prehospital components of the National Urgent Care Policy (Política Nacional de Atenção às Urgências, PNAU)--the Family Health Strategy (Estratégia de Saúde da Família, ESF) and the Mobile Emergency Care Service (Serviço de Atendimento Móvel de Urgência, SAMU)--and indicators of morbidity and mortality from stroke and acute myocardial infarction (AMI) in the elderly population in preselected municipalities of the State of Minas Gerais, Brazil. METHODS: A longitudinal ecological study was carried out. Data analysis was performed using a series of multilevel regression models. Health indicators were analyzed from 2001 to 2007. RESULTS: Statistically significant associations were found between indicators of ESF coverage and presence of SAMU with indicators of stroke and AMI mortality, for both sexes, except for male AMI. Regarding hospital admission rates, the most consistent effects were identified for female AMI. CONCLUSION: The heterogeneity of the results points to an incipient stage of PNAU, which does not allow the observation of clear effects. This finding may also suggest that this policy has not yet been able to achieve its goals concerning the elderly. Further evaluation of PNAU is essential for the establishment of strategies that can enhance its effectiveness.

Epidemiological monitoring of tuberculosis in a general teaching hospital.

OBJECTIVE: To describe the epidemiological monitoring of exposure to tuberculosis in a hospital environment and to analyze the profile of the disease in a general teaching hospital. METHODS: A descriptive and retrospective study of tuberculosis cases diagnosed between 2000 and 2006, with the determination of indicators of morbidity and mortality, which were compared with the general population of patients treated at the hospital and with the hospital employees who developed active tuberculosis. RESULTS: There were 763 patients who were treated for active tuberculosis (mean, 109 patients/year), 481 (63.1%) of whom were male. Most of the patients were in the 30-59 year age bracket. Tuberculosis that was exclusively pulmonary or extrapulmonary predominated. However, among the hospitalized patients, the combination of pulmonary and extrapulmonary tuberculosis, as well as exclusively noninfectious tuberculosis, predominated. Comorbidities were more prevalent among the hospitalized patients and among those who evolved to death. Only 52.8% of the cases treated at the hospital were reported. The overall hospital indicators showed longer length of hospital stay and greater mortality among the patients with tuberculosis. The incidence and prevalence show that there was a high risk of exposure to tuberculosis in the hospital during the period studied. CONCLUSIONS: The proposed indicators can potentially help standardize epidemiological monitoring procedures for nosocomial tuberculosis, and the epidemiological profile described in this study can contribute to a better understanding of the situation of tuberculosis in Brazil.

Monitoramento epidemiológico da tuberculose em um hospital geral universitário / Epidemiological monitoring of tuberculosis in a general teaching hospital

OBJETIVO: Descrever o monitoramento epidemiológico da exposição à tuberculose realizado em ambiente hospitalar e analisar o perfil da doença em um hospital geral universitário. MÉTODOS: Estudo descritivo e retrospectivo dos casos diagnosticados de tuberculose no período entre 2000 e 2006, com a determinação de indicadores de morbidade e mortalidade, que foram comparados a população geral de pacientes atendidos no hospital e com o total de funcionários do hospital que desenvolveram tuberculose ativa. RESULTADOS: Foram atendidos 763 pacientes com tuberculose ativa (média, 109 pacientes/ano), sendo 481 (63,1 por cento) do sexo masculino. A faixa etária mais atingida foi a de 30 a 59 anos. As formas clínicas pulmonares e extrapulmonares exclusivas foram predominantes. Entretanto, entre os pacientes internados, as formas pulmonares associadas às extrapulmonares e as formas pulmonares não bacilíferas exclusivas foram mais frequentes. A presença de comorbidades foi mais prevalente entre os pacientes internados e entre os que evoluíram para óbito. Apenas 52,8 por cento dos casos atendidos no hospital foram notificados. Os indicadores hospitalares gerais demonstraram maior tempo de internação hospitalar e mortalidade entre os pacientes com tuberculose. CONCLUSÕES: A incidência e prevalência indicam um alto risco de exposição à tuberculose no hospital no período estudado. Os indicadores propostos apresentam um potencial de padronização dos procedimentos de monitoramento da tuberculose hospitalar, e o perfil epidemiológico aqui descrito poderá contribuir para um melhor entendimento da situação da doença no país.

OBJECTIVE: To describe the epidemiological monitoring of exposure to tuberculosis in a hospital environment and to analyze the profile of the disease in a general teaching hospital. METHODS: A descriptive and retrospectivestudy of tuberculosis cases diagnosed between 2000 and 2006, with the determination of indicators of morbidity and mortality, which were compared with the general population of patients treated at the hospital and with the hospital employees who developed active tuberculosis. RESULTS: There were 763 patients who were treated for active tuberculosis (mean, 109 patients/year), 481 (63.1 percent) of whom were male. Most of the patients were in the 30-59 year age bracket. Tuberculosis that was exclusively pulmonary or extrapulmonary predominated. However, among the hospitalized patients, the combination of pulmonary and extrapulmonary tuberculosis, as well as exclusively noninfectious tuberculosis, predominated. Comorbidities were more prevalent among the hospitalized patients and among those who evolved to death. Only 52.8 percent of the cases treated at the hospital were reported. The overall hospital indicators showed longer length of hospital stay and greater mortality among the patients with tuberculosis. The incidence and prevalence show that there was a high risk of exposure to tuberculosis in the hospital during the period studied. CONCLUSIONS: The proposed indicators can potentially help standardize epidemiological monitoring procedures for nosocomial tuberculosis, and the epidemiological profile described in this study can contribute to a better understanding of the situation of tuberculosis in Brazil.

Análise da atenção pré-hospitalar ao acidente vascular cerebral e ao infarto agudo do miocárdio na população idosa de minas gerais / Analysis of pre-hospital care for stroke and myocardial infarction in the elderly population of minas gerais

OBJETIVO: Analisar a associação entre os componentes pré-hospitalares da Política Nacional de Atenção às Urgências (PNAU), a Estratégia de Saúde da Família (ESF) e o Serviço de Atendimento Móvel de Urgência (SAMU) e indicadores de morbimortalidade por acidente vascular cerebral (AVC) e infarto agudo do miorcárdio (IAM) na população idosa de municípios selecionados do Estado de Minas Gerais. MÉTODOS: Foi realizado um estudo ecológico, com delineamento longitudinal. A análise dos dados foi realizada por um conjunto de modelos de regressão multinível. Os indicadores de saúde foram analisados para os anos de 2001 a 2007. RESULTADOS: Encontrou-se associação estatisticamente significativa entre os indicadores da cobertura da ESF e a presença do SAMU com os indicadores de mortalidade por AVC e IAM, para ambos os sexos, com exceção do IAM masculino. Em relação às taxas de internação, os efeitos mais consistentes foram identificados para o IAM feminino. CONCLUSÃO: A heterogeneidade dos resultados aponta para uma fase incipiente da PNAU, que ainda não permite a observação de efeitos evidentes, o que também pode sugerir que esta política não tem sido ainda capaz de atingir suas metas em relação aos idosos. A continuidade dos processos de avaliação da PNAU é essencial para o estabelecimento de estratégias que aprimorem sua efetividade.

OBJECTIVE: To analyze the association between the pre-hospital components of the National Policy of Urgency Care (NPUC), the Family Health Strategy (FHS) and the Mobile Urgent Care Service (MUCS) and morbidity and mortality indicators of Stroke and MI in the elderly population of selected municipalities of the Minas Gerais State. METHODS: An ecological longitudinal study was performed. Data analysis was made using a set of multilevel regression models. Health indicators were analized from 2001 to 2007. RESULTS: Statistically significant associations were found between the FHS, the MUCS presence and mortality indicators of Stroke and MI, for both genders with the exception of male MI. Regarding the hospitalization rates, the most consistent effects were found for female MI. CONCLUSION: Heterogeneity of the results points to an incipient stage of the NPUC, which does not allow observation of evident effects. This might also suggest that this Policy has still not been able to achieve its goals with respect to the elderly. Continuity of the evaluation processes of the NPUC is essential to establish strategies to improve effectiveness.

Social determinants of child and adolescent traffic-related and intentional injuries: a multilevel study in Stockholm County.

Several significant developmental and socialisation processes in the life of children and adolescents take place in the area where they live. The extent to which they can feel and be safe in this environment is an important component of the success of those processes. This study highlights the independent contribution of neighbourhood and individual-level demographic and socioeconomic attributes to child and adolescent injuries. All individuals between the ages of 7 and 16 years living in Stockholm County in January 1998 (n=184 545) were followed up for their injuries during a five-year period considering injuries sustained as a pedestrian/cyclist/motor-vehicle rider and intentional injuries (violence-related and self-inflicted). A series of two-level logistic regressions were conducted to examine the association between the occurrence of injuries and individual (compositional) characteristics nested into parish of residence as well as contextual characteristics. For children and adolescents living in Stockholm County, contextual socioeconomic and social attributes of their place of residence were significant for injuries sustained as motor-vehicle riders but not for those sustained as pedestrians/cyclists or those inflicted intentionally. In the latter case, only the highest concentration of social benefit recipients was associated with significantly higher odds ratios. This emphasises that each injury mechanism has its own socioeconomic and social pathway, where contextual and compositional factors come into play to varying degrees.

Morbidity and mortality in Brazilian municipalities: a multilevel study of the association between socioeconomic and healthcare indicators.

BACKGROUND: Socioeconomic and healthcare indicators are major determinants of health outcomes. The impact of social and healthcare inequalities on Brazilian morbidity and mortality indicators is of concern but it is not well studied. METHODS: A multilevel ecological study was performed in order to investigate the association between a set of socioeconomic and healthcare indicators and five morbidity and mortality outcomes. Datasets were presented at three hierarchical levels: local (lower level), regional (intermediate level) and state (higher level). A Poisson regression model was estimated for each outcome with random intercept and fixed regression coefficients for independent variables at the three levels. The magnitude of outcome variability at intermediate and higher levels was assessed for all models. RESULTS: All outcomes were associated with both socioeconomic and healthcare variables, with predominance of associations at the local level. General and high-complexity healthcare infrastructures were directly associated with indicators related to later stages of the demographic and epidemiological transition process. A mild effect on morbidity and mortality related to political voting patterns was found at the local level. CONCLUSIONS: Healthcare conditions and socioeconomic indicators are associated with health outcomes in a complex way at the local level in Brazil, but part of the variability of health outcomes is related to factors operating at higher levels. Some possible interaction effects and cross-sectional design limitations of this study must be considered.

[Correction approach for underreporting of deaths and hospital admissions due to ill-defined causes]. / Correção de sub-registros de óbitos e proporção de internações por causas mal definidas.

OBJECTIVE: To propose a correction approach for underreporting and relocation of ill-defined causes of morbidity and mortality in the National Health System Mortality and Hospital Information Systems. METHODS: Modified James-Stein empirical Bayes estimators for events in delimited geographic areas were applied as a correction approach for underreporting in Brazilian municipalities in 2001. RESULTS: There was an increase of 55,671 deaths in the Mortality Information System, an underreporting correction of 5.85%. It was more effective at the age groups under five (8.1%) and 70 years old and more (6.4%); for neonatal (8.7%) and ill-defined (8.0%) causes of death; and in the states of Maranhão (10.6%), Bahia (9.5%) and Alagoas (8.8%). Relocation of ill-defined causes of mortality changed the structure of proportional mortality in the Northern and Northeastern regions, and increased the proportion of deaths due to cardiovascular diseases and reduced those due to external and neonatal causes. Relocation of ill-defined causes of hospital admissions did not affect hospital proportional morbidity. CONCLUSIONS: The results of underreporting correction were consistent with previous studies, in terms of age groups, causes and geographic areas. Relocation of ill-defined causes of death was spatially consistent. The approach studied may be applicable on Brazilian Health Information since it can be implemented in computational algorithms. Some improvements, however, may be considered, like estimation approaches based on time-space event distribution.

Correção de sub-registros de óbitos e proporção de internações por causas mal definidas / Correction approach for underreporting of deaths and hospital admissions due to ill-defined causes

OBJETIVO: Propor técnicas de correção de sub-registro e redistribuição de causas mal definidas para o Sistema de Informações sobre Mortalidade e o Sistema de Informações Hospitalares do SUS. MÉTODOS: Para a correção de sub-registro foram utilizados os estimadores bayesianos empíricos de James-Stein modificados para eventos em áreas geográficas delimitadas, aplicadas nos municípios brasileiros, no ano de 2001. RESULTADOS: Em relação aos dados de mortalidade, obteve-se um acréscimo de 55.671 óbitos, resultando num percentual de correção de sub-registro de 5,9 por cento, mais efetivo nas faixas etárias de menores de cinco anos (8,1 por cento) e de 70 anos e mais (6,4 por cento); nas causas perinatais (8,7 por cento) e causas mal definidas (8,0 por cento); e nos Estados do Maranhão (10,6 por cento), Bahia (9,5 por cento) e Alagoas (8,8 por cento). A redistribuição das causas mal definidas de óbito modificou a estrutura da mortalidade proporcional das regiões Norte e Nordeste, com aumento da proporção de óbitos por doenças do aparelho circulatório e redução para as causas externas e perinatais. A redistribuição das causas mal definidas de internação não alterou a morbidade hospitalar proporcional. CONCLUSÕES: Os resultados da correção de sub-registro apresentaram consistência em relação aos achados da literatura, quanto as faixas etárias, causas e regiões do País mais acometidas. Em relação à redistribuição das causas mal-definidas de morte, observou-se coerência espacial na reordenação da mortalidade proporcional. Considera-se este método aplicável aos Sistemas de Informação em Saúde nacionais, já que pode ser implementado em rotinas computacionais. Entretanto, alguns aprimoramentos podem ser considerados, como a distribuição espaço-temporal dos eventos na aplicação dos estimadores.

OBJECTIVE: To propose a correction approach for underreporting and relocation of ill-defined causes of morbidity and mortality in the National Health System Mortality and Hospital Information Systems. METHODS: Modified James-Stein empirical Bayes estimators for events in delimited geographic areas were applied as a correction approach for underreporting in Brazilian municipalities in 2001. RESULTS: There was an increase of 55,671 deaths in the Mortality Information System, an underreporting correction of 5.85 percent. It was more effective at the age groups under five (8.1 percent) and 70 years old and more (6.4 percent); for neonatal (8.7 percent) and ill-defined (8.0 percent) causes of death; and in the states of Maranhão (10.6 percent), Bahia (9.5 percent) and Alagoas (8.8 percent). Relocation of ill-defined causes of mortality changed the structure of proportional mortality in the Northern and Northeastern regions, and increased the proportion of deaths due to cardiovascular diseases and reduced those due to external and neonatal causes. Relocation of ill-defined causes of hospital admissions did not affect hospital proportional morbidity. CONCLUSIONS: The results of underreporting correction were consistent with previous studies, in terms of age groups, causes and geographic areas. Relocation of ill-defined causes of death was spatially consistent. The approach studied may be applicable on Brazilian Health Information since it can be implemented in computational algorithms. Some improvements, however, may be considered, like estimation approaches based on time-space event distribution.

Avaliação descritiva da rede hospitalar do Sistema Único de Saúde - SUS

Apresenta o estudo de nº 848 da série Textos para Discussão do IPEA, com base nos dados e informações disponíveis na pesquisa denominada Assistência Médico-Sanitária (AMS) da Fundação Instituto Brasileiro de Geografia e Estatística (IBGE), no ano de 1999 e no Sistema Único de Saúde (SUS) [DATASUS (1997, 1998 e 1999)], realiza uma análise descritiva da rede hospitalar do SUS. Documento em formato PDF, requer Acrobat Reader.

Influence of a scientific program for undergraduated medical students upon the published scientific production of professors.

Medical literature has emphasized the role of scientific research and publications in medical education. This study had the aim to detect the impact of PIC (program of scientific support) upon scientific published production of the professors teaching at Universidade Federal Fluminense. The group comprised 32 professors that participated in the PIC for at least 4 semesters. Each issue published was registered as one "product". Between 1996 and 2003, 8 years were considered for the registration of the "products" by each professor. The mean point of this period was the moment when each professor entered the program. For each professor we counted the products during the 4 years before he entered the program and during the 4 years after this occurred. Finally we summed up the products of all professors for the period before entering the program and had the mean. The same was done for the period after entering the program. Applying the paired t test, two means were reached for the two periods of scientific productivity. The same procedure was followed for two subgroups of professors: masters and doctors. The professors had 25.13 products after and 16.81 before the PIC (P< or =0.001); those with a master degree presented 16.36 products after PIC versus 5.18 before (p< or =0.08); doctors, 29.71 products after versus 22.9 products before PIC (p< or =0.028). The authors concluded that the PIC increased written production of professors, either with degree of master or doctor with relevance for those with degree of master.

[Factors associated with perinatal morbidity and mortality in a sample of public and private maternity centers in the City of Rio de Janeiro, 1999-2001]. / Fatores associados à morbi-mortalidade perinatal em uma amostra de maternidades públicas e privadas do Município do Rio de Janeiro, 1999-2001.

This study compares socio-demographic factors, mothers' biological characteristics, and quality of care at maternity hospitals in the City of Rio de Janeiro, Brazil. A sample of 10,072 post-partum women in 47 hospitals was selected. Data were collected by interviewing mothers in the immediate post-partum and from medical records. The chi2 test was used to analyze homogeneity of ratios. Significant differences were found between patients in public and private hospitals in relation to family support, healthy habits during pregnancy, reproductive history, access to and satisfaction with prenatal care and delivery, and particularly adverse effects in the newborns. Private maternity hospitals showed better results, although they displayed excessive cesarean and neonatal inter-hospital transfer rates. The stratum consisting of public Federal and State maternity hospitals received women with greater morbidity, had lower neonatal transfer rates, and received a more positive assessment by clients of the Unified National Health System (SUS). Private maternity centers contracted out by the SUS were the ones that most refused treatment to patients, leading to delays in patient care for delivery.