Family Health Strategy, Primary Health Care, and Social Inequalities in Mortality Among Older Adults in Bagé, Southern Brazil.

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.

Socio-demographic caracteristics and prevalence of risk factors in a hypertensive and diabetics population: a cross-sectional study in primary health care in Brazil.

BACKGROUND: Systemic arterial hypertension and diabetes mellitus, and their related morbidity and mortality, are currently the most common public health problems and also a higher burden of disease in Brazil. They represent a real challenge for primary health care. This study describes the methodology and baseline data of an adult population with hypertension and diabetes attending in primary health care. METHODS: It is a cross sectional study which presents data from a longitudinal research. 3784 adults were randomly selected from the registry of a health service in Porto Alegre, Brazil. The eligibility criteria were: confirmed diagnosis of hypertension and/or diabetes, consulted at least once in the prior 3 years and 18 years of age or older. Home data collection consisted of a questionnaire with information on demographic, medical history, life style and socio-economic factors. RESULTS: A total of 2482 users were interviewed (response rate of 71 %). The median age was 64 (IQR = 55.7) and the majority were women (68 %), and married (52 %). Whereas 66.5 % (CI 95 % 64.5-68.3) of the sample had only hypertension, 6.5 % (CI 95 % 5.5-7.5) had diabetes and 27.1 % (CI 95 % 25.3-28.8) had both diseases. The prevalence of diseases increased with age and with fewer years of study (p < 0.05). Subjects with both diseases had significantly more associated comorbidities. CONCLUSIONS: Hypertension and diabetes are more prevalent in older individuals, especially women, and less educated people. People suffering with both chronic conditions simultaneously are more likely to have additional comorbidities.

The Brazilian primary health care response to the COVID-19 pandemic: individual and collective approaches.

Objectives: Brazil's PHC wide coverage has a potential role in the fight against COVID, especially in less developed regions. PHC should deal with COVID-19 treatment; health surveillance; continuity of care; and social support. This article aims to analyze PHC performance profiles during the pandemic, in these axes, comparing the five Brazilian macro-regions. Methods: A cross-sectional survey study was carried out, using stratified probability sampling of PHC facilities (PHCF). A Composite Index was created, the Covid PHC Index (CPI). Factor analysis revealed that collective actions contrastingly behaved to individual actions. We verified differences in the distributions of CPI components between macro-regions and their associations with structural indicators. Results: Nine hundred and seven PHCF participated in the survey. The CPI and its axes did not exceed 70, with the highest value in surveillance (70) and the lowest in social support (59). The Individual dimension scored higher in the South, whereas the Collective dimension scored higher in the Northeast region. PHCF with the highest CPI belong to municipalities with lower HDI, GDP per capita, population, number of hospitals, and ICU beds. Conclusion: The observed profiles, individually and collectively-oriented, convey disputes on Brazilian health policies since 2016, and regional structural inequalities.

Social relationships and survival in the older adult cohort.

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.

Completeness of tuberculosis records held on the Notifiable Health Conditions Information System (SINAN) in Santa Catarina, Brazil, 2007-2016. / Completude dos registros de tuberculose no Sistema de Informação de Agravos de Notificação (Sinan) em Santa Catarina, Brasil, 2007-2016.

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.

Whither social determinants of health?

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.

csapAIH Package: The Brazilian List of Ambulatory Care Sensitive Conditions in R. / Pacote csapAIH: a Lista Brasileira de Internações por Condições Sensíveis à Atenção Primária no programa R.

OBJECTIVE: to present version 0.0.3 of the csapAIH package, developed to automate the classification and description of Ambulatory Care Sensitive Conditions (ACSC) according to the Brazilian ACSC List. METHODS: the csapAIH function was modified and novel functions were added to enable listing, tabulating and plotting of groups of causes. RESULTS: csapAIH now reads compressed (.dbc) files generated by Brazilian public hospitalization databases; the nomesgruposCSAP function lists groups of causes; descreveCSAP provides a table with the absolute frequency of groups of causes, as well as relative frequency of the overall number of hospitalizations and total ACSC; desenhaCSAP draws a horizontal barplot of groups of causes. CONCLUSION: the csapAIH package now reads .dbc files and has functions for plotting tables and graphs of groups of causes, making it easier to analyze and present results of investigation, as well as to prepare periodical ACSC monitoring reports in accordance with the Brazilian ACSC List.

Hospitalization for Ambulatory Care Sensitive Conditions in children under five years old in Santa Catarina State, Brazil, 2012: a descriptive study. / Hospitalização por Condições Sensíveis à Atenção Primária em menores de cinco anos de idade em Santa Catarina, 2012: estudo descritivo.

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.

[csapAIH: a function to classify ambulatory care sensitive conditions in the statistical software R]. / csapAIH: uma função para a classificação das condições sensíveis à atenção primária no programa estatístico R.

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.

Social relationships and survival in the older adult cohort / Relações sociais e sobrevivência na coorte de idosos / Relaciones sociales y supervivencia en la cohorte de adultos mayores

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.

Objetivo: verificar a influência das relações sociais na sobrevivência de idosos residentes no sul do Brasil. Método: estudo de coorte (2008 e 2016/17), realizado com 1.593 indivíduos com 60 anos ou mais, em entrevistas individuais. Os desfechos relações sociais e sobrevivência foram verificados por Análise de Correspondências Múltiplas que orientou a proposição de matriz explanatória para relações sociais e a análise de sobrevivência por Kaplan-Meier e análise multivariada por regressão de Cox para verificar a associação entre as variáveis independentes. Resultados: o acompanhamento foi realizado com 82,5% (n=1.314), sendo 46,1% acompanhados em 2016/17 (n=735) e 579 óbitos (36,4%). O idoso que saiu de casa diariamente teve uma redução de 39% na mortalidade e ir a festas manteve o efeito protetor de 17% para sobrevivência. O menor risco de morte para as mulheres é modificado quando os idosos vivem em domicílios com duas ou mais pessoas, neste caso as mulheres apresentam risco 89% maior de morte do que os homens. Conclusão: relações sociais fortalecidas exercem papel mediador na sobrevivência. Os achados permitiram verificar a importância de sair de casa como marcador de proteção para a sobrevivência.

Objetivo: verificar la influencia de las relaciones sociales en la supervivencia de adultos mayores residentes en el sur de Brasil. Método: estudio de cohorte (2008 y 2016/17), realizado con 1.593 individuos de 60 años o más, en entrevistas individuales. Los resultados de las relaciones sociales y la supervivencia se verificaron mediante Análisis de Correspondencias Múltiples que guio la proposición de una matriz explicativa de las relaciones sociales y el análisis de supervivencia por Kaplan-Meier y el análisis multivariado por regresión de Cox para verificar la asociación entre variables independientes. Resultados: el seguimiento se llevó a cabo con el 82,5% (n=1.314), siendo que en 46,1% el seguimiento se practicó entre 2016/17 (n=735) y se registraron 579 óbitos (36,4%). El adulto mayor que salió de casa a diario tuvo una reducción del 39% en la mortalidad y el hecho de ir a fiestas mantuvo el efecto protector del 17% en la supervivencia. El menor riesgo de muerte para las mujeres se modifica cuando los adultos mayores viven en domicilios con dos o más personas, en este caso las mujeres presentan un riesgo de muerte 89% más alto que los hombres. Conclusión: el fortalecimiento de las relaciones sociales ejerce un papel mediador en la supervivencia. Los hallazgos permitieron comprobar la importancia de salir de casa como marcador de protección en la supervivencia.

Whither social determinants of health? / Para onde seguir com a pesquisa em determinantes sociais da saúde?

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.

RESUMO Este comentário crítico retoma o debate sobre a determinação social da saúde e da doença. Seu principal argumento é o de que, se por um lado, são desnecessárias novas pesquisas que procurem conferir maior consistência aos resultados que fundamentam essa interpretação, por outro, é escassa, nesses estudos, uma análise pautada pela noção de que a pobreza e outras formas de opressão são escolhas políticas da sociedade, que devem ser situadas historicamente. Essa noção deve orientar a pesquisa e o debate na área, sob pena de que as associações encontradas supostamente para denunciar a injustiça terminem por naturalizá-la. A pesquisa pautada por esses princípios pode superar o alcance limitado de abordagens multicausais do tipo caixa-preta, que não analisam as inter-relações entre os determinantes e pouco contribuem para a construção de sociedades saudáveis.

Completude dos registros de tuberculose no Sistema de Informação de Agravos de Notificação (Sinan) em Santa Catarina, Brasil, 2007-2016 / Completitud de los registros de tuberculosis en el Sistema de Información de Agravamientos de Notificación (Sinan) en Santa Catarina, Brasil, 2007-2016 / Completeness of tuberculosis records held on the Notifiable Health Conditions Information System (SINAN) in Santa Catarina, Brazil, 2007-2016

Objetivo: descrever a completude dos registros de casos de tuberculose em Santa Catarina, Brasil, no período de 2007 a 2016. Métodos: estudo descritivo, com dados do Sistema de Informação de Agravos de Notificação; para análise de qualidade dos dados, foram consideradas a completude, a consistência dos registros das fichas de notificação e a oportunidade de notificação. Resultados: a completude dos campos obrigatórios da ficha de notificação foi considerada boa; os campos essenciais apresentaram menor completude, destacando-se a 'Escolaridade'; a baixa completude das baciloscopias de acompanhamento e a não atualização dos exames de cultura e sorologia para o HIV demonstram fragilidades no registro do boletim de acompanhamento. Conclusão: os dados do sistema de vigilância da tuberculose foram considerados adequados para orientar as ações de prevenção e controle da doença; recomenda-se o monitoramento e a avaliação periódica dos registros e a adoção de estratégias para melhoria do preenchimento do boletim de acompanhamento.

Objetivo: describir la completitud de los registros de casos de tuberculosis en Santa Catarina, Brasil, en el periodo de 2007 a 2016. Métodos: estudio descriptivo con datos del Sistema de Información de Agravamientos de Notificación; para análisis de la calidad de los datos fueron consideradas la completitud, la consistencia de los registros de las fichas de notificación y la oportunidad de notificación. Resultados: la completitud de los campos obligatorios de la ficha de notificación fue considerada buena; los campos esenciales presentaron menos completitud, destacándose el campo "Escolaridad"; la baja completitud de las baciloscopias de acompañamiento y la no actualización de los exámenes de cultivo y serología para el VIH demuestran fragilidades en el registro del formulario de seguimiento. Conclusión: los datos del sistema de vigilancia de la tuberculosis fueron considerados adecuados para orientar acciones de prevención y control de la enfermedad; se recomienda el monitoreo y la evaluación periódica de los registros y la adopción de estrategias para mejorar el llenado del formulario de seguimiento.

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.

The influence of active and passive smoking on the cardiorespiratory fitness of adults.

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.

Hospitalização por Condições Sensíveis à Atenção Primária em menores de cinco anos de idade em Santa Catarina, 2012: estudo descritivo / Hospitalización por Condiciones Sensibles a la Atención Primaria en niños de Santa Catarina, Brasil, 2012: estudio descriptivo / Hospitalization for Ambulatory Care Sensitive Conditions in children under five years old in Santa Catarina State, Brazil, 2012: a descriptive study

Objetivo: descrever as proporções e taxas de hospitalização por Condições Sensíveis à Atenção Primária (CSAP) em menores de 5 anos de idade no estado de Santa Catarina, Brasil, em 2012. Métodos: estudo descritivo, com dados do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS), classificados segundo a Lista Brasileira de CSAP. Resultados: foram registradas 32.445 hospitalizações em <5 anos de idade; as CSAP representaram 25,7% delas, com taxa de 20,1/1.000 habitantes do mesmo grupo etário; as principais causas foram gastroenterites infecciosas e complicações (26,7%), pneumonias bacterianas (22,2%) e doenças pulmonares (16,9%); houve maior taxa de hospitalização por CSAP no sexo masculino (21,1/1.000) e em menores de 1 ano de idade (43,8/1.000). Conclusão: os resultados evidenciaram que o estado de Santa Catarina apresentou taxas e proporções inferiores às observadas em outros estudos brasileiros, embora as CSAP tenham sido causa de um quarto das internações em <5 anos.

Objetivo: describir proporciones y tasas de hospitalización por Condiciones Sensibles a la Atención Primaria (CSAP) en menores de 5 años de edad en el estado de Santa Catarina, Brasil, en 2012. Métodos: estudio descriptivo, utilizando las bases del Sistema de Informaciones Hospitalarias del Sistema de Salud Brasileño (SIH/SUS), clasificadas de acuerdo a la Lista Brasileña de CSAP. Resultados: se registraron 32.445 hospitalizaciones en menores de 5 años; 25,7% de ellas representadas por las CSAP, con una tasa de 20,1/1.000 habitantes del mismo grupo de edad; las principales causas fueron gastroenteritis infecciosas y complicaciones (26,7%), neumonías bacterianas (22,2%) y enfermedades pulmonares (16,9%); se observó una mayor tasa de hospitalización por CSAP en el sexo masculino (21,1/1.000) y en <1 año de edad (43,8/1.000). Conclusión: los resultados evidenciaron que el estado de Santa Catarina presentó tasas y proporciones menores que las observadas en estudios brasileños, aunque las CSAP hayan sido la causa de » de las internaciones.

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.

Obesity and arterial hypertension in schoolchildren from Santa Cruz do Sul--RS, Brazil.

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.

Conceptual and methodological aspects in the study of hospitalizations for ambulatory care sensitive conditions.

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.

Food habits of hypertensive and diabetics cared for in a Primary Health Care service in the South of Brazil / Hábitos alimentares de hipertensos e diabéticos atendidos em um serviço de Atenção Primária à Saúde do Sul do Brasil

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. .

OBJETIVO: Descrever hábitos alimentares de hipertensos e diabéticos, classificar sua adequação de acordo com Guia Alimentar para População Brasileira do Ministério da Saúde e verificar a associação entre a adequação dos hábitos alimentares e o problema de saúde. MÉTODOS: Estudo descritivo, a partir da linha de base de um estudo longitudinal iniciado em 2011, com amostra de adultos hipertensos e diabéticos usuários de um serviço de atenção primária no sul do Brasil, entrevistados em seu domicílio. RESULTADOS: Foram analisadas 2.482 pessoas das quais 66,5% eram hipertensas, 6,5% eram diabéticas e 27,1% apresentavam hipertensão e diabetes. Dos entrevistados, 29,6% tinham hábitos alimentares inadequados, 46,9% parcialmente adequados, e 23,4% estavam adequados. Foi identificado baixo consumo de fibras e alto consumo de refrigerante, açúcar, sal e gordura saturada. A melhor adequação alimentar estava associada à pior condição de saúde, sendo que a prevalência de inadequação alimentar foi 30,0% maior nos que eram somente hipertensos. CONCLUSÃO: Os hábitos alimentares dos diabéticos e hipertensos não estavam adequados, considerando as diretrizes do Ministério da Saúde. A associação da adequação do hábito alimentar com o problema de saúde indicou uma melhora tardia do hábito alimentar, o que aponta a necessidade premente de intervenções preventivas e efetivas na promoção da alimentação saudável. .

Family Health Program and ambulatory care-sensitive conditions in Southern Brazil.

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.

Prevalência de contaminação bacteriana em estetoscópios / Prevalence of bacteria contamination on stethoscopes

O estetoscópio é um dos instrumentos mais utilizados por médicos e enfermeiros para realizar exameclínico de pacientes e esse aparelho pode atuar como veículo de transmissão de micro-organismos. Nestetrabalho, foi avaliada a prevalência da contaminação bacteriana em estetoscópios utilizados em diferentesunidades de saúde em Santa Cruz do Sul - RS, nas práticas de limpeza utilizadas pelos usuários, bemcomo o grau de informação dos profissionais sobre os procedimentos de limpeza. Foi realizado estudoobservacional, transversal e analítico em 2011, foram analisados 81 estetoscópios usados em unidadesbásicas de saúde e unidades de terapia intensiva, pediátricos e adultos, e um questionário foi aplicado.Dos 81 estetoscópios, 96,2 % estavam contaminados e Staphylococcus aureus foi o micro-organismo maisfrequentemente detectado; 55,2 % dos profissionais afirmaram que realizam a desinfecção de estetoscópios,sendo 58,8 % médicos e 52,3 % profissionais de enfermagem. Ademais, 85,7 % dos funcionários daenfermagem e 64,7 % dos médicos afirmaram que não receberam orientação por parte de instituições emque trabalham sobre os procedimentos para a limpeza dos estetoscópios. A significativa prevalência decontaminação bacteriana detectada nos estetoscópios analisados (96,2 %) demonstra a existência de riscopotencial de contaminação cruzada de infecções nosocomiais.

Estratégia saúde da família e as internações por condições sensíveis a atenção primária nos idosos / The family health strategy in relation to hospitalization for primary care sensitive conditions in elderly / La estrategia de salud familiar y condiciones hospitalarias por primaria sensible en el anciano

A Estratégia Saúde da Família (ESF) reorganiza o modelo assistencial do Sistema Único de Saúde (SUS) desde a atenção básica, garantindo ações individuais e coletivas de promoção, proteção e reabilitação da saúde a integralidade da atenção e a responsabilidade da equipe da saúde sobre a população em seu território de referência. Trata-se de estudo ecológico com o objetivo de detectar as internações por Condições Sensíveis à Atenção Primária (CSAP) em idosos na cidade de Caxias do Sul (RS), de 2000 a 2003 (antes da implantação da ESF) e 2005 a 2007 (depois da implantação da ESF). Como base de dados foram utilizados o Sistema de Informações Hospitalares do SUS e as estimativas da população residente fornecidas pelo IBGE e disponibilizadas pelo DATASUS. A tabulação dos dados foi realizada pelo programa TabWin. As variáveis estudadas foram os Coeficientes de internação por CSAP, faixa etária, sexo, período; para o ano de 2007, incluiu-se também o local (município vs. estado). Observou-se redução dos coeficientes e percentuais de internação por CSAP no município, em ambos os sexos e em todas as faixas etárias exceto em homens maiores de 80 anos. Os coeficientes em 2007 foram menores no município que no estado. Concluiu-se que a ESF pode ter contribuído para a redução observada.

The Family Health Strategy (ESF) reorganizes the model of care from the Unified Health System (SUS) starting from the primary care, ensuring individual and collective actions of promotion, protection and rehabilitation of health, integrated care and responsibility of the health care team for the population in its reference territory. This is an ecological study that aims to identify hospital admissions for Primary Care Sensitive Conditions (CSAP) in elderly inhabitants of the municipality of Caxias do Sul, RS, Brazil from 2000 to 2003 (before the implementation of the ESF) and from 2005 to 2007 (after the implementation of ESF). For data collection there was examined the Hospital Information System from SUS and the population estimates from IBGE, The Brazilian Institute of Geography and Statistics and supplied by DATASUS. The TabWin program was used for the tabulation of the data. The variables studied were the CSAP hospitalization rate, age, sex, period and for the year 2007. The region was included as well (municipality or the whole State). There was observed a reduction in CSAP hospitalization rates and percentages in the municipality, in both genders of all ages except in men older than 80 years old. In 2007, the municipality rates were lower than the State ones. It could be concluded that the ESF may have contributed to the reduction observed.

La Estrategia de Salud de la Familia (ESF) reorganiza el modelo de la atención primaria de SUS, asegurando las acciones individuales y colectivas de promoción, protección y atención integral a la rehabilitación y la responsabilidad del equipo de salud sobre la población en su territorio de referencia. Este estudio ecológico sobre las tasas de hospitalización en las personas mayores por las Condiciones de Atención Primaria Sensibles (ACSC) en Caxias do Sul, RS, 2000-2003 (antes de la aplicación del ESF) y 2005-2007 (después de la aplicación del ESF). Como base de datos se utilizó Sistema de Información Hospitalaria del SNS y de las estimaciones de la población residente (IBGE) liberadas por DATASUS. Una tabulación de los datos se realizó utilizando el programa TABWIN. Se utilizó la lista de las hospitalizaciones por ACSC en Brasil, según el Ministerio de Salud. Las variables estudiadas fueron los coeficientes de hospitalización por ACSC, edad, sexo, periodo y para el año 2007, local (ciudad vs estado). Una reducción de los coeficientes y porcentajes de hospitalización por ACSC en la ciudad, en ambos sexos y todos los grupos de edad, excepto en los hombres mayores de 80 años. Los coeficientes en 2007 fueron menores en el condado que en el estado. Llegamos a la conclusión de que el ESF puede haber contribuido a la reducción observada.