Health service accessibility and service users' position in the social space in Salvador, Bahia, Brazil, 2006: a cross-sectional study. / Acessibilidade aos serviços de saúde e posição dos usuários no espaço social em Salvador, Bahia, 2006: um estudo transversal.

OBJECTIVE: To analyze association between social position and access to health services. METHODS: This was a cross-sectional study carried out in primary health care centers in Salvador, Bahia, Brazil, where a project for improving accessibility was implemented. Pearson's chi-square test and logistic regression were used. RESULTS: 467 users took part in the study, 75.6% had not finished high school; 78.7% had <2 minimum wages; 51.8% had intermediate/qualified occupations. Low income was associated with starting to queue at the health care center the night before or before 8 a.m. (odds ratio = 2.09 - 95%CI 1.13;3.87) and spending more time scheduling an appointment (odds ratio = 2.13 - 95%CI 1.05;4.31). Having an elementary occupation was associated with face-to-face appointment scheduling (odds ratio = 1.68 - 95%CI 1.14;2.45). Education and social trajectory showed no significant association with use of health services. CONCLUSION: Social inequalities in access to health services remained after the intervention to improve accessibility.

Accessibility to health services and position of users in the social space in Salvador, Bahia, Brazil, 2006: a cross-sectional study / Accesibilidad a los servicios de salud y posición de los usuarios en el espacio social en Salvador, Bahía, Brasil, 2006: un estudio transversal / Acessibilidade aos serviços de saúde e posição dos usuários no espaço social em Salvador, Bahia, 2006: um estudo transversal

Objective: To analyze the association between social position and access to health services. Methods: Cross-sectional study in selected health units of Salvador, Bahia, Brazil. Pearson's chi-square test and logistic regression were used. Results: 467 users participated, 75.6% did not finish high school; 78.7% had <2 minimum wages; 51.8% had intermediate/qualified occupations. Low income was associated with arriving at the health unit the night before or before 8 am. (odds ratio = 2.09 ­ 95%IC 1.13;3.87) and spend more time making an appointment (odds ratio = 2.13 ­ 95%IC 1.05;4.31). Elementary occupation was associated with scheduling with face-to-face appointment scheduling (odds ratio = 1.68 ­ 95%IC 1.14;2.45). Education and social trajectory showed no significant association with the use of health services. Conclusion: Social inequalities in access to services remained after intervention to improve accessibility.

Objetivo: Analisar a associação entre posição social e acesso aos serviços de saúde. Métodos: Estudo transversal em unidades da rede básica de saúde de Salvador, Bahia, Brasil, onde foi implementado um plano para melhorar a acessibilidade. Empregou-se teste qui-quadrado de Pearson e regressão logística. Resultados: Participaram 467 usuários, dos quais 75,6% não concluíram o ensino médio, 78,7% tinham renda inferior a dois salários mínimos e 51,8% exerciam ocupações intermediárias/qualificadas. Renda baixa associou-se a chegar na unidade de saúde na noite anterior ou antes das 8h (odds ratio = 2,09 ­ IC95% 1,13;3,87) e dispender mais tempo para marcar consulta (odds ratio = 2,13 ­ IC95% 1,05;4,31). Ocupação elementar associou-se ao agendamento presencial da consulta (odds ratio = 1,68 ­ IC95% 1,14;2,45). Escolaridade e trajetória social não mostraram associação significante com utilização de serviços de saúde. Conclusão: Permaneceram desigualdades sociais no acesso aos serviços após intervenção para melhoria da acessibilidade.

Associated factors with spatial variation of adolescent pregnancy in Brazil, 2014: an ecological study of spatial clusters. / Fatores associados à variação espacial da gravidez na adolescência no Brasil, 2014: estudo ecológico de agregados espaciais.

OBJECTIVE: To identify socioeconomic and health care determinants of spatial variation in adolescent pregnancy in Brazil in 2014. METHODS: This was a spatial ecological study having municipalities as units of analysis. Spatial linear regression was used to verify association between the fertility rate in 15-19 year-old women and socioeconomic and health variables. RESULTS: The adolescent fertility rate was negatively associated with higher Family Health Strategy coverage (ß = -0.011 - 95%CI -0.017;-0.005), an adequate number of prenatal consultations (ß = -0.122 - 95%CI -0.132;-0.224) and low average family income per capita (ß = -0.104 - 95%CI -0.105;-0.103). Association was positive in relation to the Gini index (ß = 7.031 - 95%CI 4.793;9.269), low income (ß = 0.127 - 95%CI 0.108;0.145), higher household density (ß = 6.292 - 95%CI 5.062;7.522) and less schooling (ß = 0.260 - 95%CI 0.224;0.295). CONCLUSION: Reduced access to primary care and lower income are associated with higher adolescent fertility rates. Poorer socioeconomic and health care indicators are associated with higher adolescent fertility rates.

Fatores associados à variação espacial da gravidez na adolescência no Brasil, 2014: estudo ecológico de agregados espaciais / Factores asociados a la variación espacial del embarazo en la adolescencia en Brasil, 2014: estudio ecológico de agregados espaciales / Associated factors with spatial variation of adolescent pregnancy in Brazil, 2014: an ecological study of spatial clusters

Objetivo: Identificar determinantes socioeconômicos e de atenção à saúde na variação espacial da gravidez na adolescência, Brasil, 2014. Métodos: Estudo ecológico espacial com municípios como unidades de análise. Utilizou-se regressão linear espacial para verificar associações entre taxa de fecundidade em adolescentes de 15 a 19 anos e variáveis socioeconômicas e de saúde. Resultados: A fecundidade na adolescência associou-se negativamente a maior cobertura da Estratégia Saúde da Família (ß = -0,011 ­ IC95% -0,017;-0,005), número adequado de consultas de pré-natal (ß = -0,122 ­ IC95% -0,224;-0,132) e menor renda familiar média per capita (ß = -0,104 ­ IC95% -0,105;-0,103); e positivamente, ao índice de Gini (ß = 7,031 ­ IC95% 4,793;9,269), baixa renda (ß = 0,127 ­ IC95% 0,108;0,145), maior densidade domiciliar (ß = 6,292 ­ IC95% 5,062;7,522) e baixa escolaridade (ß = 0,260 ­ IC95% 0,224;0,295). Conclusão: Menores acesso a atenção básica e renda associam-se a maior taxa de fecundidade na adolescência. Piores indicadores socioeconômicos e de atenção à saúde associam-se a maior taxa de fecundidade na adolescência.

Objetivo: Identificar determinantes socioeconómicos y de atención a la salud en la variación espacial del embarazo adolescente en Brasil en 2014. Métodos Estudio espacial ecológico con municipios como unidades de análisis. La regresión lineal espacial se utilizó para verificar la asociación entre la tasa de fecundidad adolescente (15-19 años) y variables socioeconómicas y de salud. Resultados: La tasa de fecundidad adolescente se asoció negativamente con mayor cobertura de la Estrategia de Salud Familiar (ß = -0,011 ­ IC95% -0,017;-0,005), número adecuado de consultas prenatales (ß = -0.122 ­ IC95% -0,132;-0,224) e bajo ingreso familiar promedio per cápita (ß = -0,104 ­ IC95% -0,105;-0,103). Esta asociación fue positiva con el índice de Gini (ß = 7,031 ­ IC95% 4,793; 9,269), bajos ingresos (ß = 0,127 ­ IC95% 0,108; 0,145), mayor densidad familiar (ß = 6,292 ­ IC95% 5,062; 7,522) y baja escolaridad (ß = 0,260 ­ IC95% 0,224; 0,295). Conclusión: El menor acceso a la atención primaria y menores ingresos están asociados con una mayor fecundidad en la adolescencia. Los peores indicadores socioeconómicos y de atención a la salud se asocian con una mayor tasa de fecundidad en la adolescencia.

Objective: To identify socioeconomic and health care determinants of spatial variation in adolescent pregnancy in Brazil in 2014. Methods: This was a spatial ecological study having municipalities as units of analysis. Spatial linear regression was used to verify association between the fertility rate in 15-19 year-old women and socioeconomic and health variables. Results: The adolescent fertility rate was negatively associated with higher Family Health Strategy coverage (ß = -0.011 - 95%CI -0.017;-0.005), an adequate number of prenatal consultations (ß = -0.122 - 95%CI -0.132;-0.224) and low average family income per capita (ß = -0.104 - 95%CI -0.105;-0.103). Association was positive in relation to the Gini index (ß = 7.031 - 95%CI 4.793;9.269), low income (ß = 0.127 - 95%CI 0.108;0.145), higher household density (ß = 6.292 - 95%CI 5.062;7.522) and less schooling (ß = 0.260 - 95%CI 0.224;0.295). Conclusion: Reduced access to primary care and lower income are associated with higher adolescent fertility rates. Poorer socioeconomic and health care indicators are associated with higher adolescent fertility rates.

Acessibilidade aos serviços de saúde e posição dos usuários no espaço social em Salvador, Bahia, 2006: um estudo transversal / Health service accessibility and service users' position in the social space in Salvador, Bahia, Brazil, 2006: a cross-sectional study

Objetivo: Analisar a associação entre posição social e acesso aos serviços de saúde. Métodos: Estudo transversal em unidades da rede básica de saúde de Salvador, Bahia, Brasil, onde foi implementado um plano para melhorar a acessibilidade. Empregou-se teste qui-quadrado de Pearson e regressão logística. Resultados: Participaram 467 usuários, dos quais 75,6% não concluíram o ensino médio, 78,7% tinham renda inferior a dois salários mínimos e 51,8% exerciam ocupações intermediárias/qualificadas. Renda baixa associou-se a chegar na unidade de saúde na noite anterior ou antes das 8h (odds ratio = 2,09 - IC95% 1,13;3,87) e dispender mais tempo para marcar consulta (odds ratio = 2,13 - IC95% 1,05;4,31). Ocupação elementar associou-se ao agendamento presencial da consulta (odds ratio = 1,68 - IC95% 1,14;2,45). Escolaridade e trajetória social não mostraram associação significante com utilização de serviços de saúde. Conclusão: Permaneceram desigualdades sociais no acesso aos serviços após intervenção para melhoria da acessibilidade.

Objetivo: Analizar la asociación entre posición social y acceso a servicios de salud. Métodos: Estudio transversal en unidades de salud en Salvador, Bahía, Brasil. Se utilizó pruebas de chi-cuadrado de Pearson y regresión logística. Resultados: Participaron 467 usuarios, 75,6% no terminó la escuela secundaria, 78.7% tenía ingreso <2 salarios mínimos, 51.8% tenía ocupaciones intermedias/calificadas. Bajos ingresos asociaron con llegada a la unidad de salud la noche anterior o antes de las 8 a.m. (odds ratio = 2,09 - IC95% 1,13;3,87) y tomar más tiempo para programar una cita (odds ratio = 2,13 - IC95% 1,05;4,31). Ocupación elemental se asoció con programación de citas en persona (odds ratio = 1,68 - IC95% 1,14;2,45). Escolaridad y trayectoria social no mostraron asociación significativa con el uso de servicios de salud. Conclusión: Las desigualdades sociales en el acceso a los servicios se mantuvieron después de la intervención.

Objective: To analyze association between social position and access to health services. Methods: This was a cross-sectional study carried out in primary health care centers in Salvador, Bahia, Brazil, where a project for improving accessibility was implemented. Pearson's chi-square test and logistic regression were used. Results: 467 users took part in the study, 75.6% had not finished high school; 78.7% had <2 minimum wages; 51.8% had intermediate/qualified occupations. Low income was associated with starting to queue at the health care center the night before or before 8 a.m. (odds ratio = 2.09 - 95%CI 1.13;3.87) and spending more time scheduling an appointment (odds ratio = 2.13 - 95%CI 1.05;4.31). Having an elementary occupation was associated with face-to-face appointment scheduling (odds ratio = 1.68 - 95%CI 1.14;2.45). Education and social trajectory showed no significant association with use of health services. Conclusion: Social inequalities in access to health services remained after the intervention to improve accessibility.

Cross-sectional study of the anthropometric characteristics of children with congenital Zika syndrome up to 12 months of life.

BACKGROUND: Little is known about physical development of children with Congenital Zika Syndrome (CZS). This study aims to evaluate the anthropometric characteristics of children with CZS up to 12 months. METHODS: This is a cross-sectional study developed with 46 children with CZS living in Bahia. We used the Public Health Events Register, Live Births Information System and Childcare Records of Primary Health Care Services. Descriptive analysis was performed by distributing absolute and relative frequencies and median and interquartile range. The Weight/Age (W/A), Length/Age (L/A), Weight/Length (W/L) and Head Circumference/Age (HC/A) indexes were calculated for each month and expressed in z-score values, and the results were evaluated individually and by group average. Values between ≥ - 2 and ≤ 2 standard deviations were used as reference. T-Student and Spearman's Correlation Tests were applied to verify the existence of any relationship between maternal and children's variables with the anthropometric indexes weight/age and height/age at birth and at 3, 6 and 12 months of age. RESULTS: The studied children had high proportions of low birth weight (23.9%), dysphagia (56.8%) and seizures (53.5%). The mean z-score for the HC/A index at birth was - 3.20 and remained below - 3 z-scores throughout the assessed period. The analysis of the indices equivalent to every single child's anthropometric measurement showed a deficit in 20.4% of the W/A, 39.1% of the L/A, 9.2% of the W/L and 85.7% of the HC/A measurements. Distribution of the mean values of these anthropometric indices revealed a risk of delayed stature growth (L/A < -1 z-score). There was a statistically significant association between L/A at 12 months and dysphagia (p = 0.0148) and a positive correlation between breastfeeding time and W/A. No statistically significant correlation was found between any other tested variables. CONCLUSIONS: We observed a deficit in the HC/A index, which is a common feature in CZS, but also a high proportion of W/A and L/A deficit. The average group z-score highlighted the risk of delay in stature growth for age, which calls attention to the need for health interventions, as this condition exposes them to a higher risk of morbidity and mortality.

Associated factors to spatial variation of pregnancy in adolescence in Brazil, 2014: ecological study of spatial aggregates / Factores asociados a la variación espacial del embarazo en la adolescencia en Brasil, 2014: estudio ecológico de agregados espaciales / Fatores associados à variação espacial da gravidez na adolescência no Brasil, 2014: estudo ecológico de agregados espaciais

Objective. To identify socioeconomic and health care determinants of the spatial variation of teenage pregnancy in Brazil in 2014. Methods. Spatial ecological study with municipalities as units of analysis. Spatial linear regression was used to verify the association between fertility in adolescence (15-19 years) and socioeconomic and health variables. Results. Fertility rate in adolescence was negatively associated with greater coverage of the Family Health Strategy (ß = -0.011 ­ 95%CI -0.017;-0.005), an adequate number of prenatal consultations (ß = -0.122 ­ 95%CI -0.132;-0.224) and low per capita average family income (ß = -0.104 ­ 95%CI -0.105;-0.103). This association was positive in relation to the Gini index (ß = 7.031 ­ 95%CI 95%CI 4.793;9.269), low income (ß = 0.127 ­ 95%CI 0.108;0.145), household crowding (ß = 6.292 ­ 95%CI 5.062;7.522) and less education (ß = 0.260 ­ 95%CI 0.224;0.295). Conclusion. Lack of access to primary care and lower income are associated with higher fertility in adolescence. Worse socioeconomic and health care indicators are associated with higher fertility rate in adolescence.

Objetivo. Identificar determinantes socioeconômicos e de atenção à saúde na variação espacial da gravidez na adolescência, Brasil, 2014. Métodos. Estudo ecológico espacial com municípios como unidades de análise. Utilizou-se regressão linear espacial para verificar associações entre taxa de fecundidade aos 15-19 anos e variáveis socioeconômicas e de saúde. Resultados. A fecundidade na adolescência associou-se negativamente a maior cobertura da Estratégia Saúde da Família (ß = -0,011 ­ IC95% -0,017;-0,005), número adequado de consultas de pré-natal (ß = -0,122 ­ IC95% -0,224;-0,132) e menor renda familiar média per capita (ß = -0,104 ­ IC95% -0,105;-0,103); e positivamente, ao índice de Gini (ß = 7,031 ­ IC95% 4,793;9,269), baixa renda (ß = 0,127 ­ IC95% 0,108;0,145), maior densidade domiciliar (ß = 6,292 ­ IC95% 5,062;7,522) e baixa escolaridade (ß = 0,260 ­ IC95% 0,224;0,295). Conclusão. Menor acesso a atenção básica e renda associam-se a maior taxa de fecundidade na adolescência. Piores indicadores socioeconômicos e de atenção à saúde associam-se a maior taxa de fecundidade na adolescência.

Congenital syphilis distribution in the State of Tocantins, Brazil, 2007-2015. / Distribuição da sífilis congênita no estado do Tocantins, 2007-2015.

OBJECTIVE: to describe the epidemiological profile of congenital syphilis (CS) in Tocantins, from 2007 to 2015. METHODS: this was a cross-sectional descriptive study conducted with data from the Notifiable Health Conditions Information System (SINAN) and the Live Birth Information System (SINASC). RESULTS: 1,029 CS cases were reported; mean CS incidence was 4.6/1,000 Live Births (LB), increasing from 3.1/1,000 LB in 2007 to 9.8/1,000 LB in 2015 (increase of 216.1%); municipalities located in the central and northern regions of the state had the highest rates; the majority of mothers of newborn babies were 15-24 years old, had elementary school education, started prenatal care in the third trimester of pregnancy, and received inadequate prenatal care. CONCLUSION: high occurrence of congenital syphilis in Tocantins requires immediate intensification of CS surveillance and improved prenatal care quality, especially in municipalities with higher incidence.

Obesity and periodontitis are not associated in pregnant women.

OBJECTIVE: The objective of this study was to investigate an association between obesity (exposure) and periodontitis (outcome) in pregnant women. BACKGROUND: This association was investigated and only five studies were identified as showing a positive association. However, some of these studies had limitations such as reduced sample sizes, inadequate exposure criteria and outcome measures, which question the internal validity of these investigations. METHODS: A cross-sectional study was carried out with a sample of 644 pregnant women of the public health service of the municipality of Santo Antônio de Jesus, Bahia, Brazil. Data were obtained by collecting of socioeconomic-demographic information, health behavior, health conditions, and reproductive history through an interview. Obesity was evaluated using body mass index adjusted for gestational age and expected weight gain. The diagnosis of periodontitis followed two criteria: (a) Center for Disease Prevention and Control and American Academy of Periodontology (CDC/AAP); (b) Gomes-Filho et al (2018) using criterion that also evaluated bleeding upon probing; Prevalence ratios and respective 95% confidence intervals were obtained by Poisson regression analysis. RESULTS: In accordance with the outcome diagnostic criterion, the frequency of periodontitis was 17.24% (Gomes-Filho et al) and 66.92% (CDC/AAP). The participants were classified as low weight (19.72%), adequate weight (42.39%), overweight (24.84%), and obesity (13.04%), based on the exposure diagnostic criterion. The low weight and overweight groups were excluded from the data analysis, giving a final sample of 357 pregnant women. The association between obesity in pregnant women and periodontitis was not statistically significant, after adjusting for confounders such as age, schooling level, alcoholic beverage consumption, alimentary and nutritional orientation, urinary infection, and dental flossing. CONCLUSIONS: The findings showed a high frequency of periodontitis, obesity, and overweight in the studied population but no association between obesity and periodontitis in pregnant women was found.

Distribuição da sífilis congênita no estado do Tocantins, 2007-2015 / Distribución de la sífilis congénita en el estado de Tocantins, Brasil, 2007-2015 / Congenital syphilis distribution in the State of Tocantins, Brazil, 2007-2015

Objetivo: descrever o perfil epidemiológico da sífilis congênita no estado do Tocantins, Brasil, de 2007 a 2015. Métodos: estudo transversal descritivo, realizado com dados do Sistema de Informação de Agravos de Notificação (Sinan) e do Sistema de Informações sobre Nascidos Vivos (Sinasc). Resultados: foram notificados 1.029 casos da doença; a incidência média foi de 4,6 casos por 1 mil nascidos vivos (NV), com aumento de 3,1/1 mil NV em 2007 para a 9,8/1 mil NV em 2015 (aumento de 216,1%); municípios localizados no centro e no norte do estado apresentaram maiores taxas; a maioria das mães dos recém-nascidos tinha 15-24 anos de idade, ensino fundamental, iniciou o pré-natal no 3º trimestre de gestação e recebeu assistência pré-natal inadequada. Conclusão: a elevada ocorrência da sífilis congênita no Tocantins demanda imediata intensificação da vigilância da doença e melhoria da qualidade do acompanhamento pré-natal, especialmente nos municípios com maior incidência.

Objetivo: describir el perfil epidemiológico de la sífilis congénita (SC) en Tocantins, de 2007 a 2015. Métodos: estudio transversal descriptivo, con datos del Sistema Nacional de Agravamientos de Información (Sinan) y del Sistema de Informaciones sobre Nacidos Vivos (Sinasc). Resultados: se notificaron 1.029 casos de SC; la incidencia promedio fue de 4,6/1000 nacidos vivos (NV), con aumento variando de 3,1/1000 NV en 2007 a 9,8/1000 NV en 2015 (aumento del 216,1%); los municipios ubicados en el centro y norte del estado presentaron mayores tasas; la mayoría de las madres tenía entre 15-24 años, enseñanza primaria, iniciaron el prenatal en el 3º trimestre de gestación y la asistencia prenatal recibida fue inadecuada. Conclusión: la situación epidemiológica de la sífilis congénita en Tocantins es muy preocupante y demanda la inmediata intensificación de esfuerzos, principalmente en lo que se refiere a mejorar la calidad del prenatal, especialmente en los municipios con mayor incidencia de la enfermedad.

Objective: to describe the epidemiological profile of congenital syphilis (CS) in Tocantins, from 2007 to 2015. Methods: this was a cross-sectional descriptive study conducted with data from the Notifiable Health Conditions Information System (SINAN) and the Live Birth Information System (SINASC). Results: 1,029 CS cases were reported; mean CS incidence was 4.6/1,000 Live Births (LB), increasing from 3.1/1,000 LB in 2007 to 9.8/1,000 LB in 2015 (increase of 216.1%); municipalities located in the central and northern regions of the state had the highest rates; the majority of mothers of newborn babies were 15-24 years old, had elementary school education, started prenatal care in the third trimester of pregnancy, and received inadequate prenatal care. Conclusion: high occurrence of congenital syphilis in Tocantins requires immediate intensification of CS surveillance and improved prenatal care quality, especially in municipalities with higher incidence.

Congenital Zika Syndrome: Prevalence of low birth weight and associated factors. Bahia, 2015-2017.

OBJECTIVE: The clinical manifestations of Congenital Zika Syndrome (CZS) are not fully known, for example its effect on birth weight. This study estimated the prevalence of low birth weight (LBW) among children with CZS, and identified associated factors. METHODS: Cross-sectional study involving 393 children with CZS living in Bahia, Brazil, in 2015-2017. Official Information Systems were the data sources. We calculated LBW prevalence and applied Logistic Regression to assess associated factors. RESULTS: Prevalence of LBW among children with CZS was 37.2%. Excluding pre-term births the proportion was 29.9%. This prevalence was 81.0% and 28.0% among children born pre-term and term/post term, respectively. There was a higher proportion (53.2%) in female children, and in those delivered by cesarean section (51.4%). Most mothers were single/separated (62.1%) and had a low level of schooling (70.0%). In the model adjusted for type of delivery, preterm births presented a 10.8 times greater chance of presenting LBW than term/post-term ones. However, the Confidence Interval was very wide. Adjusting for gestation duration, children born by cesarean section had a 1.63 higher probability of presenting LBW than those born by vaginal delivery (OR=1,63; CI95% 1.01, 2.63). CONCLUSIONS: The prevalence of LBW among children with CZS was very elevated, both preterm and term/post-term live births. This can contribute to increasing their risk for morbimortality. The association of LBW with prematurity and cesarean deliveries is known, but in children with CZS, it has not been clarified whether or not this is related to pathological conditions caused by fetal infection by the Zika virus.

Health surveillance at the SUS: development, effects and perspectives. / Vigilância em Saúde no SUS - construção, efeitos e perspectivas.

This article analyses the process of construction of Health Surveillance in Brazil concerning the political, historical and organizational context of this component of the Unified Health System (UHS), by means of its historical view and presentation of the advances, limits, setbacks and perspectives. Throughout trajectory of Health Surveillance, its objects of study and intervention have been expanded, strengthening the integration among the different areas of surveillance, increasing its capacity for prediction and intervention. It evolved from surveillance of people, to surveillance of diseases and now to surveillance of health risks, promoting greater articulation of HS professionals with agents of endemics and Family Health Teams. The first National Health Surveillance Conference, in February 2018, provided opportunities for discussion and formulation of proposals aimed at strengthening HS, expanding its scope of actions with a view to achieving a comprehensive care model. Adequate and audacious alternatives are necessary so that there are no setbacks in the financing modalities in order to maintain and expand the advances achieved in the field of Health Surveillance in Brazil.

Este artigo analisa o processo de construção da Vigilância em Saúde/VS no Brasil abordando o contexto político, histórico e organizacional deste componente do Sistema Único de Saúde, por meio do resgate histórico e apresentação dos avanços, limites, retrocessos e perspectivas. Ao longo da trajetória da VS, seus objetos de estudo e intervenção vêm se ampliando, fortalecendo a integração entre as diversas áreas da vigilância, aumentando sua capacidade de predição e intervenção. Evoluiu-se da vigilância das pessoas, para a das doenças e agora para a de riscos à saúde. A convocação da 1ª Conferência Nacional de Vigilância em Saúde, a ser realizada em 2018, oportuniza revisão e formulação de proposições voltadas para o fortalecimento da VS, expansão do seu escopo de ações e busca de alternativas adequadas e arrojadas, que garantam que a nova modalidade de financiamento do SUS aprovada em 2017, de fato, venha reforçar os avanços conquistados por este no campo da Saúde Coletiva.

The achievements of the SUS in tackling the communicable diseases. / Conquistas do SUS no enfrentamento das doenças transmissíveis.

This article presents the development of the epidemiological situation of some of the major communicable diseases (CD) in Brazil, with emphasis on the interventions by the SUS and other social policies. The data and information were collected from Datasus, epidemiological newsletters from the Brazilian Ministry of Health, and scientific articles on the issue. The universalization, decentralization and expansion of the surveillance, control and prevention of CD has produced an impact on the morbidity and mortality of these diseases, mainly those which are vaccine-preventable. The emergence and re-emergence of three arboviruses, for which there are no effective control instruments, interrupted the downward trend in the morbidity profile of CD in Brazil. Other social and economic programs, which are geared to the needier sectors of the Brazilian population, have also contributed to the improvement of the analyzed health indicators. However, the universalization of access to healthcare services, as well as improvements in the scope of the surveillance of diseases and health risks, has played a key role in improving the health and quality of life of the population, as well as contributing to the process of the democratization of Brazil.

Apresenta-se a evolução da situação epidemiológica de algumas das principais Doenças transmissíveis (DT) no Brasil, assinalando as intervenções proporcionadas pelo SUS e outras políticas sociais. Dados e informações foram levantados do Datasus e Boletins epidemiológicos do Ministério da Saúde e de artigos científicos sobre o tema. A universalização, a descentralização e a ampliação das ações de vigilância, controle e prevenção de DT produziram impacto sobre a morbimortalidade dessas doenças, principalmente das imunopreveníveis. A emergência e reemergência de três arboviroses, para as quais não se dispõe de instrumentos de controle efetivos, interromperam a evolução decrescente no perfil de morbidade das DT no Brasil. Outros programas sociais e econômicos, voltados para a população brasileira mais carente, também contribuíram para a melhoria dos indicadores de saúde analisados. Contudo, a universalização do acesso aos serviços de atenção à saúde, ao lado do aperfeiçoamento do escopo de atuação da vigilância sobre doenças e riscos à saúde, vem desempenhando papel fundamental na melhoria das condições de saúde e qualidade de vida da população, bem como contribuindo para o processo de democratização do país.

Conquistas do SUS no enfrentamento das doenças transmissíveis / The achievements of the SUS in tackling the communicable diseases

Resumo Apresenta-se a evolução da situação epidemiológica de algumas das principais Doenças transmissíveis (DT) no Brasil, assinalando as intervenções proporcionadas pelo SUS e outras políticas sociais. Dados e informações foram levantados do Datasus e Boletins epidemiológicos do Ministério da Saúde e de artigos científicos sobre o tema. A universalização, a descentralização e a ampliação das ações de vigilância, controle e prevenção de DT produziram impacto sobre a morbimortalidade dessas doenças, principalmente das imunopreveníveis. A emergência e reemergência de três arboviroses, para as quais não se dispõe de instrumentos de controle efetivos, interromperam a evolução decrescente no perfil de morbidade das DT no Brasil. Outros programas sociais e econômicos, voltados para a população brasileira mais carente, também contribuíram para a melhoria dos indicadores de saúde analisados. Contudo, a universalização do acesso aos serviços de atenção à saúde, ao lado do aperfeiçoamento do escopo de atuação da vigilância sobre doenças e riscos à saúde, vem desempenhando papel fundamental na melhoria das condições de saúde e qualidade de vida da população, bem como contribuindo para o processo de democratização do país.

Abstract This article presents the development of the epidemiological situation of some of the major communicable diseases (CD) in Brazil, with emphasis on the interventions by the SUS and other social policies. The data and information were collected from Datasus, epidemiological newsletters from the Brazilian Ministry of Health, and scientific articles on the issue. The universalization, decentralization and expansion of the surveillance, control and prevention of CD has produced an impact on the morbidity and mortality of these diseases, mainly those which are vaccine-preventable. The emergence and re-emergence of three arboviruses, for which there are no effective control instruments, interrupted the downward trend in the morbidity profile of CD in Brazil. Other social and economic programs, which are geared to the needier sectors of the Brazilian population, have also contributed to the improvement of the analyzed health indicators. However, the universalization of access to healthcare services, as well as improvements in the scope of the surveillance of diseases and health risks, has played a key role in improving the health and quality of life of the population, as well as contributing to the process of the democratization of Brazil.

Vigilância em Saúde no SUS - construção, efeitos e perspectivas / Health surveillance at the SUS: development, effects and perspectives

Resumo Este artigo analisa o processo de construção da Vigilância em Saúde/VS no Brasil abordando o contexto político, histórico e organizacional deste componente do Sistema Único de Saúde, por meio do resgate histórico e apresentação dos avanços, limites, retrocessos e perspectivas. Ao longo da trajetória da VS, seus objetos de estudo e intervenção vêm se ampliando, fortalecendo a integração entre as diversas áreas da vigilância, aumentando sua capacidade de predição e intervenção. Evoluiu-se da vigilância das pessoas, para a das doenças e agora para a de riscos à saúde. A convocação da 1ª Conferência Nacional de Vigilância em Saúde, a ser realizada em 2018, oportuniza revisão e formulação de proposições voltadas para o fortalecimento da VS, expansão do seu escopo de ações e busca de alternativas adequadas e arrojadas, que garantam que a nova modalidade de financiamento do SUS aprovada em 2017, de fato, venha reforçar os avanços conquistados por este no campo da Saúde Coletiva.

Abstract This article analyses the process of construction of Health Surveillance in Brazil concerning the political, historical and organizational context of this component of the Unified Health System (UHS), by means of its historical view and presentation of the advances, limits, setbacks and perspectives. Throughout trajectory of Health Surveillance, its objects of study and intervention have been expanded, strengthening the integration among the different areas of surveillance, increasing its capacity for prediction and intervention. It evolved from surveillance of people, to surveillance of diseases and now to surveillance of health risks, promoting greater articulation of HS professionals with agents of endemics and Family Health Teams. The first National Health Surveillance Conference, in February 2018, provided opportunities for discussion and formulation of proposals aimed at strengthening HS, expanding its scope of actions with a view to achieving a comprehensive care model. Adequate and audacious alternatives are necessary so that there are no setbacks in the financing modalities in order to maintain and expand the advances achieved in the field of Health Surveillance in Brazil.

Association between periodontitis and severe asthma in adults: A case-control study.

OBJECTIVE: To evaluate the association between periodontitis and severe asthma, with participants in treatment for severe asthma, controlled by therapy. METHODS: A case-control investigation was performed to compare 130 adults with severe asthma with 130 without asthma. Individuals with periodontitis were those with ≥4 teeth with ≥1 site with probing depth ≥4 mm, clinical attachment level ≥3 mm, and bleeding upon probing at the same site. Severe asthma diagnosis was based on Global Initiative for Asthma criteria. RESULTS: Association between exposure to periodontitis and severe asthma was found: ORcrude  = 2.98 (95% CI: 1.74-5.11). When confounders were considered, the association between exposure to periodontitis and severe asthma was maintained: ORadjusted  = 3.01-3.25. Individuals with periodontitis had about a threefold increased risk of severe asthma than those without periodontitis. Frequency of periodontitis in participants with severe asthma was greater than that of those without asthma (46.6% vs 22.3%, p ≤ .05). CONCLUSIONS: Association between periodontitis and severe asthma was observed. Further investigation is required to determine the direction of this relationship. It may be causal, but it may also be a consequence of the immunopathological process that characterizes asthma, or else, consequence of the medication used for treatment.

Spatial patterns of preventable perinatal mortality in Salvador, Bahia, Brazil.

OBJECTIVE: To identify the spatial distribution patterns and areas of higher risk of preventable perinatal mortality in the city of Salvador, State of Bahia, Brazil. METHODS: We carried out a spatial aggregated study in 2007, considering the weighting areas (census tracts contiguous sets) of Salvador, of which the center and north present low life conditions. Data were obtained from national vital statistics systems and the 2010 Census. Addresses of live births and stillbirths were geocoded by weighting area. The spatial distribution of the perinatal mortality rate was analyzed from thematic maps. Spatial dependence was evaluated by the Global and Local Geary's and Moran's Indexes. RESULTS: Crude and smoothed perinatal mortality rates were high in areas situated to the north, west, and in center of Salvador. The smoothed rates in weighting areas ranged from 4.9/1,000 to 22.3/1,000 births. Of all perinatal deaths, 92.1% could have been prevented. We identified spatial dependence for preventable perinatal mortality for care in pregnancy, with neighboring areas with high risk in the north of the city. CONCLUSIONS: The preventability potential of perinatal mortality was high in Salvador, in 2007. The spatial distribution pattern with higher rates in disadvantaged areas of the city suggests the existence of social inequalities in health. The characteristics of the process of urban development of Salvador, which has inadequate prenatal care, possibly influenced the magnitude and spatial distribution pattern of this mortality.

Spatial patterns of preventable perinatal mortality in Salvador, Bahia, Brazil

ABSTRACT OBJECTIVE To identify the spatial distribution patterns and areas of higher risk of preventable perinatal mortality in the city of Salvador, State of Bahia, Brazil. METHODS We carried out a spatial aggregated study in 2007, considering the weighting areas (census tracts contiguous sets) of Salvador, of which the center and north present low life conditions. Data were obtained from national vital statistics systems and the 2010 Census. Addresses of live births and stillbirths were geocoded by weighting area. The spatial distribution of the perinatal mortality rate was analyzed from thematic maps. Spatial dependence was evaluated by the Global and Local Geary's and Moran's Indexes. RESULTS Crude and smoothed perinatal mortality rates were high in areas situated to the north, west, and in center of Salvador. The smoothed rates in weighting areas ranged from 4.9/1,000 to 22.3/1,000 births. Of all perinatal deaths, 92.1% could have been prevented. We identified spatial dependence for preventable perinatal mortality for care in pregnancy, with neighboring areas with high risk in the north of the city. CONCLUSIONS The preventability potential of perinatal mortality was high in Salvador, in 2007. The spatial distribution pattern with higher rates in disadvantaged areas of the city suggests the existence of social inequalities in health. The characteristics of the process of urban development of Salvador, which has inadequate prenatal care, possibly influenced the magnitude and spatial distribution pattern of this mortality.

Leprosy in children and adolescents under 15 years old in an urban centre in Brazil

This original study describes the intra-urban distribution of cases of leprosy in residents under 15 years old in Salvador, Bahia, Brazil; the study also identifies the environment in which Mycobacterium leprae is being transmitted. The cases were distributed by operational classification, clinical forms, type of contact and the addresses were geo-referenced by neighborhood. Between 2007 and 2011, were reported 145 cases of leprosy in target population living in Salvador, corresponding to detection rates of 6.21, 6.14, 5.58, 5.41 and 6.88/100,000 inhabitants, respectively. The spatial distribution of the disease was focal. Of the 157 neighborhoods of Salvador, 44 (28.6%) notified cases of leprosy and in 22 (50%) of these were detected more than 10 cases per 100,000 inhabitants. The infectious forms were found in 40% of cases. Over 90% of cases had been living in Salvador for more than five years. Overall, 52.6% reported having had contact with another infected individual inside the household and 25% in their social circle. In Salvador, M. leprae transmission is established. The situation is a major concern, since transmission is intense at an early age, indicating that this endemic disease is expanding and contacts extend beyond individual households.

Leprosy in children and adolescents under 15 years old in an urban centre in Brazil.

This original study describes the intra-urban distribution of cases of leprosy in residents under 15 years old in Salvador, Bahia, Brazil; the study also identifies the environment in which Mycobacterium leprae is being transmitted. The cases were distributed by operational classification, clinical forms, type of contact and the addresses were geo-referenced by neighborhood. Between 2007 and 2011, were reported 145 cases of leprosy in target population living in Salvador, corresponding to detection rates of 6.21, 6.14, 5.58, 5.41 and 6.88/100,000 inhabitants, respectively. The spatial distribution of the disease was focal. Of the 157 neighborhoods of Salvador, 44 (28.6%) notified cases of leprosy and in 22 (50%) of these were detected more than 10 cases per 100,000 inhabitants. The infectious forms were found in 40% of cases. Over 90% of cases had been living in Salvador for more than five years. Overall, 52.6% reported having had contact with another infected individual inside the household and 25% in their social circle. In Salvador, M. leprae transmission is established. The situation is a major concern, since transmission is intense at an early age, indicating that this endemic disease is expanding and contacts extend beyond individual households.