Physical disability, recent illnesses and health self-assessment in a population-based study in São Paulo, Brazil

Objectives: To investigate health self-assessment and to estimate the prevalence of chronic diseases and recent illnesses in people with and without physical disabilities (PD) in the state of São Paulo, southeastern Brazil...

Factors associated with added sugars intake among adolescents living in São Paulo, Brazil.

OBJECTIVE: To measure added sugars intake among adolescents and describe its demographic, socioeconomic, and nutritional status determinants. DESIGN: The study was conducted based on a household survey carried out between March and December 2003. Food intake was assessed through 24-hour food recalls, and an adjustment approach was applied using external variance estimates derived from 195 adolescents of the same age in 2007. SETTING: Population-based cross-sectional study, city of São Paulo, Brazil. SUBJECTS: Seven hundred and ninety-three male (n = 410) and female (n = 383) adolescents aged 10-19 years. MEASURE OF OUTCOME: Foods with greater contributions toward the added sugars intake were identified. Multiple linear regression analysis was performed, with calories from added sugars as the dependent continuous variable and the remaining factors (socioeconomic, demographic, lifestyle, household condition, and food intake) as independent variables. RESULTS: The average contribution of added sugars to total energy value was 12.28% (95% confidence interval [CI]: 11.87-12.70) with no statistically significant sex difference (p > 0.05). Soft drinks were a major source of added sugars among the adolescents (34.2% among males and 32.0% among females), followed by sugars (sucrose and honey) and chocolate powder (around 11%). In the multiple linear regression analysis, the head of household's education level and calories from protein, fats, and carbohydrates other than sugars had an independent effect on added sugars intake. CONCLUSIONS: This study showed that the percentage contribution of added sugars to energy intake among adolescents in the city of São Paulo, Brazil, was above the current recommended levels. Socioeconomic condition (represented by the head of the household's education level) and macronutrient intake were shown to be determinants of sugars intake.

Problems with accessibility to health services by persons with disabilities in São Paulo, Brazil.

PURPOSE: To describe the occurrence of self-reported problems of accessibility to health services used by persons with disabilities in terms of social and health services variables. METHODS: We performed a cross-sectional household survey designed to assess problems with accessibility to health services faced by persons with disabilities. We interviewed 333 persons in São Paulo city, in 2007. Variables related to the presence of accessibility problems, disabilities, gender, age, family head income, ethnicity, use of health services and others were analysed using frequencies, percentages, χ(2)-test, ANOVA and Poisson regression models. RESULTS: 15.92% of the interviewed persons reported problems with accessibility to health services. Persons having multiple (prevalence ratios; PR = 2.91) or mobility disability (PR = 6.46) had more problems with accessibility than persons with hearing disability. Persons younger than 78 years old had more problems with accessibility; those who needed help to go to the health service (PR = 3.01) also. CONCLUSIONS: Persons with multiple or mobility disability, younger than 78 years, and those who needed help of others to go to the health service were more likely to have problems with accessibility to health services. This information could be one of the first steps to the management and/or planning of appropriate health services for persons with disabilities.

Physical disability, recent illnesses and health self-assessment in a population-based study in São Paulo, Brazil.

OBJECTIVES: To investigate health self-assessment and to estimate the prevalence of chronic diseases and recent illnesses in people with and without physical disabilities (PD) in the state of São Paulo, southeastern Brazil. STUDY DESIGN: A cross-sectional study comprising two population-based health surveys conducted in 2002 and 2003. METHODS: A total of 8317 persons (165 with PD) were interviewed in the two studies. Variables concerning to health self-assessment; chronic disease and recent illness were compared in the people with and without PD. Negative binomial regression was used in the analysis. RESULTS: Subjects with PD more often assessed their health as poor/very poor compared to non-disabled ones. They reported more illnesses in the 15 days prior to interview as well as more chronic diseases (skin conditions, anaemia, chronic kidney disease, stroke, depression/anxiety, migraine/headache, pulmonary diseases, hypertension, diabetes, arthritis/arthrosis/rheumatic conditions and heart disease). This higher disease prevalence can be either attributed to disability itself or be associated to gender, age and schooling. CONCLUSIONS: Subjects with PD had more recent illnesses and chronic diseases and poorer health self-assessment than non-disabled ones. Age, gender, schooling and disability have individual roles in disease development among disabled people.

Formação de gestores locais de saúde: processos para identificar estratégias de atuação / Training of local health managers: process of identification of strategic actions

No Brasil, nos anos recentes, e acompanhando a maior participação dos municípios nas ações de saúde, observa-se a necessidade crescente de instrumentos que possam contribuir para a melhor formação de gestores locais, complementares às atividades de natureza acadêmica. Nesse sentido realizou-se estudo com o objetivo de construir processo de capacitação de gestores mediante seleção de focos de abordagem para identificar estratégias efetivas para modificação das condições de saúde. Foi feita uma experiência para desenvolvimento de "estudos de casos", com 8 municípios considerados bem sucedidos das regiões Norte e Nordeste do Brasil, com utilização da abordagem por focos na estruturação das informações. Com base nessas informações, foi realizado seminário com 21 gestores locais das duas regiões, reunindo pequenos grupos e intermediando com atividades coletivas. Durante o seminário, gestores municipais de saúde adquiriram maior conhecimento das estratégias implementadas e identificaram alternativas concretas de intervenção para as suas realidades. A proposta metodológica de ensino por estudo de caso utilizando uma prévia elaboração conceitual mediante o agrupamento das diversas dimensões dos casos, facilitou a formação de gestores municipais de saúde a partir de experiências práticas