A Percepção do Sistema de Saúde por Estudantes de Medicina através do Uso de Portfólio Reflexivo / Medical Students' Perceptions of the Brazilian Public Health System, expressed in a Reflective Portfolio

RESUMO A mudança no modo de pensar os cursos de Medicina e o perfil de médico que se espera formar no Brasil desde 2001 acabou por afetar as pessoas e instituições envolvidas nesse processo. Neste estudo buscou-se compreender como os estudantes de Medicina de uma universidade privada percebem o modelo de médico segundo o qual estão sendo formados e se entendem o sistema em que estarão inseridos após sua formatura. Para isto, foi realizado um estudo qualitativo com base nos portfólios dos acadêmicos do último período do curso de Medicina dessa universidade nos anos de 2013 e de 2014. A análise dos portfólios considerou o que se espera da formação médica no Brasil desde 2001: médicos generalistas com formação humanista, crítica, reflexiva e ética. Os resultados mostraram que a maioria dos alunos consegue identificar as diretrizes do sistema de saúde e como este se organiza, mas não se identifica com o cenário e os profissionais que nele atuam. Quanto ao seu papel nesse contexto, alguns adotaram a posição de espectadores, enquanto poucos se reconheceram como parte no processo de mudança necessário ao alcance das diretrizes do Sistema Único de Saúde (SUS). Os estudantes acreditavam que a Estratégia Saúde da Família (ESF) poderia dar certo, mas não se sentiam parte desse sistema, olhando de fora, descrevendo, mas não percebendo esse lugar como seu e nem como o lugar do seu paciente imaginado.

ABSTRACT The way of thinking about medicine courses, and the profile of future physicians in Brazil have changed since 2001, and this has affected the institutions and people involved in this process. This article analyzes medical students' views on what is expected of them after graduation, and the new concept of physician expected by the public health care system in Brazil. It is a qualitative study, based on portfolios developed by students in their final period in the years 2013 and 2014. Analysis of the portfolios considered the expectations generated by the students' expectations of medical schools in Brazil since 2001, i.e., to produce general physicians with a humanistic, critical, reflective and ethical training. The results revealed that most students think about the public health system, and know and understand how it is organized, but they do not identify themselves either with the scenario, or with the professionals who work within it. Regarding their role as students in this context, some students adopted the position of spectators, while others recognized how important they are in helping to change the system in line with SUS guidelines. Finally, the students believe that the ESF may work, but they do not feel part of this system and do not recognize the patients they meet there as their idealized patient.

Brazilian guidelines for community-acquired pneumonia in immunocompetent adults - 2009.

Community-acquired pneumonia continues to be the acute infectious disease that has the greatest medical and social impact regarding morbidity and treatment costs. Children and the elderly are more susceptible to severe complications, thereby justifying the fact that the prevention measures adopted have focused on these age brackets. Despite the advances in the knowledge of etiology and physiopathology, as well as the improvement in preliminary clinical and therapeutic methods, various questions merit further investigation. This is due to the clinical, social, demographical and structural diversity, which cannot be fully predicted. Consequently, guidelines are published in order to compile the most recent knowledge in a systematic way and to promote the rational use of that knowledge in medical practice. Therefore, guidelines are not a rigid set of rules that must be followed, but first and foremost a tool to be used in a critical way, bearing in mind the variability of biological and human responses within their individual and social contexts. This document represents the conclusion of a detailed discussion among the members of the Scientific Board and Respiratory Infection Committee of the Brazilian Thoracic Association. The objective of the work group was to present relevant topics in order to update the previous guidelines. We attempted to avoid the repetition of consensual concepts. The principal objective of creating this document was to present a compilation of the recent advances published in the literature and, consequently, to contribute to improving the quality of the medical care provided to immunocompetent adult patients with community-acquired pneumonia.

Diretrizes brasileiras para pneumonia adquirida na comunidade em adultos imunocompetentes - 2009 / Brazilian guidelines for community-acquired pneumonia in immunocompetent adults - 2009

A pneumonia adquirida na comunidade mantém-se como a doença infecciosa aguda de maior impacto médico-social quanto à morbidade e a custos relacionados ao tratamento. Os grupos etários mais suscetíveis de complicações graves situam-se entre os extremos de idade, fato que tem justificado a adoção de medidas de prevenção dirigidas a esses estratos populacionais. Apesar do avanço no conhecimento no campo da etiologia e da fisiopatologia, assim como no aperfeiçoamento dos métodos propedêuticos e terapêuticos, inúmeros pontos merecem ainda investigação adicional. Isto se deve à diversidade clínica, social, demográfica e estrutural, que são tópicos que não podem ser previstos em sua totalidade. Dessa forma, a publicação de diretrizes visa agrupar de maneira sistematizada o conhecimento atualizado e propor sua aplicação racional na prática médica. Não se trata, portanto, de uma regra rígida a ser seguida, mas, antes, de uma ferramenta para ser utilizada de forma crítica, tendo em vista a variabilidade da resposta biológica e do ser humano, no seu contexto individual e social. Esta diretriz constitui o resultado de uma discussão ampla entre os membros do Conselho Científico e da Comissão de Infecções Respiratórias da Sociedade Brasileira de Pneumologia e Tisiologia. O grupo de trabalho propôs-se a apresentar tópicos considerados relevantes, visando a uma atualização da diretriz anterior. Evitou-se, tanto quanto possível, uma repetição dos conceitos considerados consensuais. O objetivo principal do documento é a apresentação organizada dos avanços proporcionados pela literatura recente e, desta forma, contribuir para a melhora da assistência ao paciente adulto imunocompetente portador de pneumonia adquirida na comunidade.

Community-acquired pneumonia continues to be the acute infectious disease that has the greatest medical and social impact regarding morbidity and treatment costs. Children and the elderly are more susceptible to severe complications, thereby justifying the fact that the prevention measures adopted have focused on these age brackets. Despite the advances in the knowledge of etiology and physiopathology, as well as the improvement in preliminary clinical and therapeutic methods, various questions merit further investigation. This is due to the clinical, social, demographical and structural diversity, which cannot be fully predicted. Consequently, guidelines are published in order to compile the most recent knowledge in a systematic way and to promote the rational use of that knowledge in medical practice. Therefore, guidelines are not a rigid set of rules that must be followed, but first and foremost a tool to be used in a critical way, bearing in mind the variability of biological and human responses within their individual and social contexts. This document represents the conclusion of a detailed discussion among the members of the Scientific Board and Respiratory Infection Committee of the Brazilian Thoracic Association. The objective of the work group was to present relevant topics in order to update the previous guidelines. We attempted to avoid the repetition of consensual concepts. The principal objective of creating this document was to present a compilation of the recent advances published in the literature and, consequently, to contribute to improving the quality of the medical care provided to immunocompetent adult patients with community-acquired pneumonia.

Parto normal X parto cesáreo: análise epidemiológica em duas maternidades no sul do Brasil / Normal delivery X caesarian delivery: epidemilogic analysis in two maternities in the south of Brazil

Introdução: Os índices de cesariana vêm aumentando consideravelmente nos últimos anos, mesmo com o conhecimento prévio de que o parto normal é mais seguro, tanto para a mãe, quanto para o bebê. Métodos: Em um estudo retrospectivo, foram analisados 1.479 partos ocorridos na Maternidade da Santa Casa de Misericórdia de Pelotas (SCMP) e 1.522 partos na Maternidade do Hospital São Francisco de Paula (HUFSP), no período de 01/01/2007 a 31/12/2007 e comparados com os dados obtidos em estudo anterior com o mesmo objetivo no período de 01/07/1993 a 30/06/1994. Resultados: Foi observado um incremento dos partos cesáreos nas duas instituições, com 41,1% dos partos da SCMP e 40,7% no HUSFP realizados por via alta. Houve similaridade com relação ao peso dos recém-nascidos de gestantes submetidas à via alta de parto, encontrando-se a maioria com peso entre 2.501g e 3.500g, o que foge ao preconizado pela indicação obstétrica que recomenda tal via em fetos macrossômicos diante do maior risco de desproporção cefalopélvica. Também foi observado que a maioria dos partos cesáreos foram realizados em mulheres entre 21 e 30 anos. Em comparação com os dados de 1994, observou-se que houve aumento na proporção de cesarianas em todas as categorias de peso do recém-nascido e idade materna, mas com maior prevalência nos fetos macrossômicos. Conclusão: Este estudo constatou uma incidência aumentada de partos cesáreos nas maternidades estudadas em relação ao preconizado pelo Ministério da Saúde (AU)

Introduction: The rates of caesarian surgeries have been increasing considerably in recent years, despite the awareness that normal delivery is safer both for the mother and for the infant. Methods: In a retrospective study, we evaluated 1,479 deliveries in the Santa Casa de Misericórdia of Pelotas, RS (SCMP) and 1,522 deliveries in the Hospital São Francisco de Paula, RS (HUFSP) from January 1, 2007 to December 31, 2007, which were compared to the data obtained in a previous study carried out for the same purpose from July 1, 1993 to June 30, 1994. Results: An increase in the number of caesarian sections was observed, accounting for 41.1% of the deliveries in the SCMP and for 40.7% in the HUSFP. There was similarity concerning birth weight of pregnant women submitted to caesarian sections, most of them weighing from 2,501g to 3,500g, which is out of the obstetrical recommendation of using such route for macrosomic fetuses because of the greater risk of cephalo-pelvic disproportion. Most of the caesarian deliveries were performed in women between 21 and 30 years of age. As compared to 1994 data, there was an increase in the percentage of caesarian sections in all categories of birth weight and maternal age, but with a greater prevalence in macrosomic fetuses. Conclusions: This study has found an increased incidence of caesarian surgeries in the studied hospitals as compared to what is recommended by the Ministry of Health (AU)

Asthma and lung function in a birth cohort at 6-7 years of age in southern Brazil.

OBJECTIVE: Asthma and respiratory symptoms are common in children, and many studies have shown associations between childhood symptoms and impaired lung function in adult life. The aim of the present study was to investigate the association of various respiratory symptoms with wheezing patterns (persistent, early, and late-onset) and lung function, as well as to determine whether lung function was associated with atopy or with demographic, socioeconomic, environmental, and gestational factors, in a birth cohort at 6-7 years of age. METHODS: The target population consisted of children aged 6-7 years from a birth cohort of 5,304 children born in southern Brazil in 1993. For this follow-up evaluation, 532 of those children were randomly selected, and a sub-sample was submitted to spirometry and skin prick tests. A questionnaire was administered to the parent(s) or legal guardian(s) of each child. RESULTS: Spirometric values were lower in the children with respiratory symptoms or asthma. Mean forced expiratory volume in one second/forced vital capacity ratio (FEV1/FVC ratio) was lower in children with any of the following: current wheezing and asthma; asthma ever; four or more episodes of wheezing within the preceding 12 months; sleep disturbance due to wheezing; and exercise-induced wheezing. Persistent wheezing was associated with lower FEV1/FVC ratio. After multiple linear regression, exercise-induced wheezing was also associated with reduced FEV1/FVC ratio. Nonwhite skin color and wheezing severe enough to limit speech were associated with lower FEV1. CONCLUSIONS: Children with persistent wheezing and symptoms of severe asthma have impaired lung function at 6-7 years of age.

Asma e função pulmonar aos 6-7 anos de idade em uma coorte de nascimentos no Sul do Brasil / Asthma and lung function in a birth cohort at 6-7 years of age in southern Brazil

OBJECTIVE: Asthma and respiratory symptoms are common in children, and many studies have shown associations between childhood symptoms and impaired lung function in adult life. The aim of the present study was to investigate the association of various respiratory symptoms with wheezing patterns (persistent, early, and late-onset) and lung function, as well as to determine whether lung function was associated with atopy or with demographic, socioeconomic, environmental, and gestational factors, in a birth cohort at 6-7 years of age. METHODS: The target population consisted of children aged 6-7 years from a birth cohort of 5,304 children born in southern Brazil in 1993. For this follow-up evaluation, 532 of those children were randomly selected, and a sub-sample was submitted to spirometry and skin prick tests. A questionnaire was administered to the parent(s) or legal guardian(s) of each child. RESULTS: Spirometric values were lower in the children with respiratory symptoms or asthma. Mean forced expiratory volume in one second/forced vital capacity ratio (FEV1/FVC ratio) was lower in children with any of the following: current wheezing and asthma; asthma ever; four or more episodes of wheezing within the preceding 12 months; sleep disturbance due to wheezing; and exercise-induced wheezing. Persistent wheezing was associated with lower FEV1/FVC ratio. After multiple linear regression, exercise-induced wheezing was also associated with reduced FEV1/FVC ratio. Nonwhite skin color and wheezing severe enough to limit speech were associated with lower FEV1. CONCLUSIONS: Children with persistent wheezing and symptoms of severe asthma have impaired lung function at 6-7 years of age.

OBJETIVO: Asma e sintomas respiratórios são comuns na infância, e vários estudos têm demonstrado sua associação com redução da função pulmonar na vida adulta. O objetivo deste estudo foi investigar a associação de diversos sintomas respiratórios com padrões de sibilância (persistente, precoce e de início tardio) e função pulmonar aos 6-7 anos de idade em uma coorte de nascimentos, além de determinar se a função pulmonar estava associada à atopia ou a fatores demográficos, socioeconômicos, ambientais e gestacionais. MÉTODOS: A populaçãoalvo compreendeu crianças de 6 a 7 anos de idade pertencentes à coorte de 5.304 nascimentos ocorridos em 1993 em Pelotas, no Sul do Brasil. Para esse acompanhamento selecionaram-se aleatoriamente 532 dessas crianças, e uma subamostra foi submetida a espirometria e testes cutâneos de puntura. Aplicou-se um questionário aos pais das crianças ou seus responsáveis. RESULTADOS: Observamos valores espirométricos mais baixos nas crianças com sintomas respiratórios e asma. A média da relação volume expiratório forçado no primeiro segundo/capacidade vital forçada (relação VEF1/CVF) foi menor nas crianças com sibilância atual e asma, asma alguma vez na vida, quatro ou mais episódios de sibilância nos últimos 12 meses, sono perturbado pela sibilância e sibilância após exercícios. Sibilância persistente foi associada a redução da relação VEF1/CVF. Após regressão linear múltipla, sibilância após exercícios também foi associada a redução da relação VEF1/CVF. Cor da pele não-branca e fala prejudicada pela sibilância foram associadas a VEF1 reduzido. CONCLUSÕES: Crianças com sibilância persistente e sintomas de asma grave apresentaram função pulmonar prejudicada aos 6-7 anos de idade.

[Quality of primary care as measured by preventable hospitalizations in the South of Brazil]. / Qualidade da atenção básica mediante internações evitáveis no Sul do Brasil.

This study assessed the quality of primary care in Pelotas, Rio Grande do Sul, Brazil, through preventable hospitalization rates (1995-2004). Preventable hospitalizations were defined as those related to the following diseases: diabetes mellitus, congestive heart failure, hypertension, chronic obstructive pulmonary disease, and vaccine-preventable diseases (polio, diphtheria, tetanus, whooping cough, and measles). Men and women from 20 to 59 years of age were included in the study. The proportion of preventable causes among hospital admissions was higher for women than for men. From 1995 to 2004 there was a decrease in preventable hospitalization rates. Even after direct standardization, analysis showed that admission rates in Pelotas were lower than for the State of Rio Grande do Sul as a whole. Preventable hospitalization costs decreased in parallel with the drop in hospital admission rates. The decrease in hospitalizations is consistent with improvement in primary health care. However, the findings may result from the system's financial model. Reimbursement for hospital procedures is low, which could induce the hospitals to curtail admissions.

[Wheezing phenotypes from birth to adolescence: a cohort study in Pelotas, Brazil, 1993-2004]. / Padrões de sibilância respiratória do nascimento até o início da adolescência: coorte de Pelotas (RS) Brasil, 1993-2004.

OBJECTIVE: To study the prevalence of wheezing patterns and their associations with independent variables. METHODS: Cohort study of live births in 1993 in Pelotas, Brazil. A systematic subsample (20%) of the original cohort was evaluated at 6 months, 12 months and 4 years. At 10-12 years, 87.5% of the original cohort was contacted. Wheezing was categorized: transient, wheezing at 4 years but not at 10-12; persistent, wheezing at all evaluations; late-onset, wheezing at 10-12 years. Independent variables were analyzed: gender; skin color; family income; smoking/asthma during pregnancy; breastfeeding; respiratory infection/diarrhea (during the 1st year); family members with asthma/allergy (at 4 years and at 10-12); physician-diagnosed rhinitis/eczema (at 10-12 years). RESULTS: The subsample comprised 897 adolescents. Wheezing patterns were expressed as prevalence (95% CI): transient, 43.9% (40.7-47.2); persistent, 6.4% (4.8-8.0); and late-onset, 3.3% (2.2-4.5). The transient pattern was more common in children from low-income families, children breastfed for less time, children with a history of respiratory infections (during the 1st year) and children with asthma in the family (at 4 years). The persistent pattern was almost twice as common in males, in children whose mothers had asthma during pregnancy, in children with respiratory infections (during the 1st year) and in children with asthma in the family (at 4 and 10-12 years). The late-onset pattern was more prevalent among those with asthma in the family (at 10-12 years) and those diagnosed with rhinitis (at 10-12 years), being less prevalent among those reporting respiratory infections (during the 1st year) and those diagnosed with eczema (at 10-12 years). CONCLUSIONS: Knowledge of the associations of wheezing patterns allows us to adopt preventive and therapeutic measures.

Qualidade da atenção básica mediante internações evitáveis no Sul do Brasil / Quality of primary care as measured by preventable hospitalizations in the South of Brazil

Realizou-se estudo para avaliar mediante taxa de internações hospitalares evitáveis a qualidade dos cuidados oferecidos pela rede básica de saúde em Pelotas, Rio Grande do Sul, Brasil, no período entre 1995 a 2004. Foram consideradas como internações evitáveis: diabetes mellitus, insuficiência cardíaca, hipertensão arterial sistêmica, doença pulmonar obstrutiva crônica e doenças imunopreveníveis (poliomielite, difteria, tétano, coqueluche, sarampo). Foram incluídos homens e mulheres de 20 a 59 anos. Os percentuais entre as mulheres foram superiores aos encontrados nos homens. Foi observada uma diminuição dos percentuais de internações tanto nos homens como nas mulheres no decorrer do período. Mesmo após a padronização direta revelou-se que as taxas de internação de Pelotas foram inferiores às do Rio Grande do Sul. Os custos das hospitalizações evitáveis acompanharam a queda observada nas taxas de internações. Aparentemente, a diminuição verificada nas taxas de internações evitáveis pode estar relacionada à qualificação dos serviços de atenção básica. Contudo, os resultados podem ser conseqüências do financiamento do sistema de saúde. Os valores de pagamento desses procedimentos são baixos e podem estar direcionando os hospitais a uma diminuição da oferta de leitos.

This study assessed the quality of primary care in Pelotas, Rio Grande do Sul, Brazil, through preventable hospitalization rates (1995-2004). Preventable hospitalizations were defined as those related to the following diseases: diabetes mellitus, congestive heart failure, hypertension, chronic obstructive pulmonary disease, and vaccine-preventable diseases (polio, diphtheria, tetanus, whooping cough, and measles). Men and women from 20 to 59 years of age were included in the study. The proportion of preventable causes among hospital admissions was higher for women than for men. From 1995 to 2004 there was a decrease in preventable hospitalization rates. Even after direct standardization, analysis showed that admission rates in Pelotas were lower than for the State of Rio Grande do Sul as a whole. Preventable hospitalization costs decreased in parallel with the drop in hospital admission rates. The decrease in hospitalizations is consistent with improvement in primary health care. However, the findings may result from the system's financial model. Reimbursement for hospital procedures is low, which could induce the hospitals to curtail admissions.

Padrões de sibilância respiratória do nascimento até o início da adolescência: coorte de Pelotas (RS) Brasil, 1993-2004 / Wheezing phenotypes from birth to adolescence: a cohort study in Pelotas, Brazil, 1993-2004

OBJETIVO: Estudar a prevalência dos padrões de sibilância respiratória e suas associações com variáveis independentes. MÉTODOS: Coorte de nascidos vivos, 1993, Pelotas (RS); subamostra sistemática de 20 por cento da coorte original acompanhada aos 6 e 12 meses e 4 anos; aos 10-12 anos localizou-se 87,5 por cento da coorte original. Definição dos padrões: transitório: chiado até 4 anos e ausência de chiado aos 10-12 anos; persistente: chiado em todos acompanhamentos; início tardio: chiado aos 10-12 anos. Variáveis independentes: gênero; cor da pele; renda familiar; fumo/asma na gravidez; amamentação; infecção respiratória/diarréia (1º ano); alergia e asma na família (4 e 10-12 anos); diagnóstico médico de rinite/eczema (10-12 anos). RESULTADOS: O total da subamostra foi de 897 adolescentes. Prevalência (IC95 por cento) dos padrões de sibilância: transitório 43,9 por cento (40,7-47,2);persistente 6,4 por cento (4,8-8,0); de início tardio 3,3 por cento (2,2-4,5). O transitório foi mais freqüente em crianças de famílias de baixa renda, com menor duração da amamentação, relato de infecções respiratórias (1º ano) e história familiar de asma (4 anos); o persistente foi quase duas vezes mais freqüente em meninos, em filhos de mulheres com asma na gravidez, com infecções respiratórias (1º ano) e história familiar de asma (4 e 10-12 anos); de início tardio mostrou maior prevalência naqueles com asma na família (10-12 anos) e diagnóstico médico de rinite (10-12 anos); menor prevalência em quem relatou infecções respiratórias (1º ano) e diagnóstico médico de eczema (10-12 anos). CONCLUSÕES: O conhecimento das associações dos padrões sibilantes permite a adoção de medidas preventivas e terapêuticas.

OBJECTIVE: To study the prevalence of wheezing patterns and their associations with independent variables. METHODS: Cohort study of live births in 1993 in Pelotas, Brazil. A systematic subsample (20 percent) of the original cohort was evaluated at 6 months, 12 months and 4 years. At 10-12 years, 87.5 percent of the original cohort was contacted. Wheezing was categorized: transient, wheezing at 4 years but not at 10-12; persistent, wheezing at all evaluations; late-onset, wheezing at 10-12 years. Independent variables were analyzed: gender; skin color; family income; smoking/asthma during pregnancy; breastfeeding; respiratory infection/diarrhea (during the 1st year); family members with asthma/allergy (at 4 years and at 10-12); physician-diagnosed rhinitis/eczema (at 10-12 years). RESULTS: The subsample comprised 897 adolescents. Wheezing patterns were expressed as prevalence (95 percent CI): transient, 43.9 percent (40.7-47.2); persistent, 6.4 percent (4.8-8.0); and late-onset, 3.3 percent (2.2-4.5). The transient pattern was more common in children from low-income families, children breastfed for less time, children with a history of respiratory infections (during the 1st year) and children with asthma in the family (at 4 years). The persistent pattern was almost twice as common in males, in children whose mothers had asthma during pregnancy, in children with respiratory infections (during the 1st year) and in children with asthma in the family (at 4 and 10-12 years). The late-onset pattern was more prevalent among those with asthma in the family (at 10-12 years) and those diagnosed with rhinitis (at 10-12 years), being less prevalent among those reporting respiratory infections (during the 1st year) and those diagnosed with eczema (at 10-12 years). CONCLUSIONS: Knowledge of the associations of wheezing patterns allows us to adopt preventive and therapeutic measures.

Perfil epidemiológico da tuberculose empelotas - rio grande do sul - brasil / Epidemiological profile of tuberculosis in Pelotas - Rio Grande do Sul - Brazil

Objetivo: Traçar o perfil epidemiológico dos casos detuberculose na cidade de Pelotas-RS, entre os anos de 2001-2005. Material e Métodos: Análise do banco de dados doSistema de Informação de Agravos de Notificação (SINAN/MS), com um total de 1.007 casos de tuberculose, 213 em2001, 185 em 2002, 210 em 2003, 203 em 2004 e 180 em2005. Resultados: Verificaram-se maiores ocorrências nafaixa etária de 20-39 anos, na raça branca e no grupo deescolaridade de 4-7 anos concluídos. A maioria dasnotificações foi de casos novos, a forma clínica predominantefoi pulmonar e o sexo masculino teve maior prevalência deco-infecção com HIV, o que se repetiu em todos os anosestudados. Quanto à situação de encerramento, detectouseque o percentual de cura diminuiu no período de 2001 a2005 e o de óbitos aumentou no mesmo período. Conclusão:Deste modo, considera-se oportuno o planejamento deestratégias que tenham como objetivo primordial, além dadetecção precoce da doença, o acompanhamento dosindivíduos doentes, a fim de se obter resultados satisfatóriosno encerramento do tratamento, permitindo assim umaqualidade de vida melhor e a diminuição da mortalidade portuberculose no Brasil.

Objective: The objective of this work was trace theepidemiological profile of cases of tuberculosis in the city ofPelotas-RS, between the years 2001-2005, Material eMethods: Analysis of the RS tuberculosis database (SINAN/MS), with a total of 1007 cases of tuberculosis, 213 in 2001,185 in 2002, 210 in 2003, 203 in 2004, 180 in 2005. Results:There were majority events in the age group of 20-39 years,in white race and the group of 4-7 years of schoolingcompleted. Most notifications were of new cases and clinicalform predominant was pulmonary and the relation to coinfectionHIV, the prevalence was higher among males in allthe years studied. As for the situation of closure, found thatthe percentage of cure decreased during the period 2001 to2005 and of deaths increased in the same period.Conclusions: Thus, it is considered appropriate to theplanning of strategies that have as their primary objective,furthermore early detection of disease, monitoring of theindividual patients, to obtain satisfactory results in thetermination of treatment, allowing a better quality of life andreduction of mortality for tuberculosis in Brazil.

Risk factors for wheezing in early adolescence: a prospective birth cohort study in Brazil.

BACKGROUND: Many asthma studies are available in the literature, but few investigated whether risk factors for asthma differ by sex. OBJECTIVE: To evaluate risk factors for wheezing in early adolescence, with emphasis on sex differences. METHODS: A prospective birth cohort study was initiated in 1993; 87.5% of the original cohort was traced at 11 years, totaling 4,452 adolescents. Current wheezing was defined as at least 1 crisis in the previous 12 months. The following independent variables were analyzed: maternal smoking during pregnancy, wheezing at 4 years, maternal wheezing, and adolescent body mass index. RESULTS: Current wheezing affected 13.5% (95% confidence interval [CI], 12.4%-14.5%) of the cohort. The prevalence of current wheezing was 15.3% (95% CI, 13.7%-16.8%) in boys and 11.7% (95% CI, 10.4%-13.1%) in girls (P < .001). Maternal smoking was related to an increased risk of wheezing for boys but not for girls. There was a significant tracking of wheezing from 4 to 11 years in both sexes, although the magnitude was stronger for boys. A dose-response association between maternal wheezing and adolescent wheezing was observed in boys but not in girls. Finally, obesity was associated with an increased risk of wheezing in boys but not in girls. CONCLUSIONS: The variables explored in this investigation had a stronger effect on adolescent wheezing in boys than in girls. Public health strategies aimed at minimizing the burden of wheezing should take these sex differences into account.

[Prevalence and risk factors for asthma in schoolchildren in southern Brazil]. / Prevalência e fatores de risco para asma em escolares de uma coorte no Sul do Brasil.

OBJECTIVE: To study the prevalence and risk factors for asthma in a cohort of 494 children born in 1993 and followed up to the age of six years in Pelotas, state of Rio Grande do Sul, Brazil. METHODS: A standardized and validated asthma questionnaire, based on the International Study of Asthma and Allergies in Childhood (ISAAC), was applied. Other information was also collected about socioeconomic background, genetic, nutritional, gestational and allergic factors, and previous infectious episodes. RESULTS: The prevalence of asthma found in this study was 12.8% (95%CI: 10-15.9%). In the multivariate analysis, risk factors such as non-white skin color (RR = 1.9 95% CI: 1.1-3.3%), family history of asthma (RR = 2.8 95% CI: 1.5-5.1), allergic rhinitis in children (RR = 2.6 95% CI: 1.5-4.4) and maternal smoking during pregnancy (RR = 1.7 95%CI: 1-2.9) were associated with asthma. CONCLUSION: Childhood asthma is highly prevalent in Pelotas, and it is a serious public health problem. Therefore, specific programs should be developed for its control.

Prevalência e fatores de risco para asma em escolares de uma coorte no Sul do Brasil / Prevalence and risk factors for asthma in schoolchildren in southern Brazil

OBJETIVOS: Estudar a prevalência e fatores de risco para asma em 494 crianças pertencentes à coorte de nascidos em 1993, as quais vêm sendo acompanhadas desde o nascimento, estando, atualmente, com cerca de 6 anos de idade, em Pelotas (RS). MÉTODOS: Foi administrado um questionário padronizado com questões relativas à asma, baseadas em questionário utilizado por um estudo internacional multicêntrico (ISAAC) validado em diversos países. Também obteve-se informações sobre o nível socioeconômico, fatores ambientais, hereditários, nutricionais, gestacionais, alérgicos e eventos infecciosos pregressos. RESULTADOS: A prevalência de asma encontrada foi de 12,8 por cento (IC95 por cento: 10-15,9 por cento). Na análise multivariada, a asma esteve associada com cor da pele não-branca (RR = 1,9 IC95 por cento: 1,1-3,3 por cento), história de asma na família (RR = 2,8 IC95 por cento:1,5-5,1), rinite alérgica na criança (RR = 2,6 IC95 por cento:1,5-4,4) e fumo na gestação (RR = 1,7 IC95 por cento:1-2,9). CONCLUSÃO: A asma infantil tem elevada prevalência em Pelotas, sendo um problema de saúde pública e, como tal, deve-se direcionar ações apropriadas para o seu controle.

[The association between low birthweight and asthma: a systematic literature review]. / Associação entre baixo peso ao nascer e asma: uma revisão sistemática da literatura.

OBJECTIVE: To determine if there is an association between low birthweight (< 2,500 g) and asthma. RESULTS: The key words "asthma," "children," "birth weight," and "risk factors" were used to identify analytical epidemiological studies on humans that were published in English, Portuguese, or Spanish between 1990 and 2001 and that were indexed in either of two bibliographic databases: MEDLINE (PubMed) and Latin American and Caribbean Health Sciences (Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS)). We identified 41 articles dealing with the association between birthweight and asthma: 21 were longitudinal studies, 16 were cross-sectional studies, and 4 were case-control studies. Low birthweight was identified as a risk factor for asthma in 26 of the articles. Two studies found an inverse association between birthweight and risk for asthma, and 15 did not find any association. CONCLUSIONS: The association between low birthweight and asthma remains controversial, mainly due to the extensive network of factors that contribute to the development of asthma. The association between low birthweight and asthma occurs mainly among children up to 5 years of age, and it decreases as age increases. Pulmonary function is an important factor that needs to be considered. Low birthweight children may have decreased pulmonary function and consequently develop asthma. On the other hand, these children may have asthma as a consequence of low birthweight, without pulmonary function being a factor. In the six studies comparing low birthweight children (< 2,500 g) with very low birthweight children (< 1,500 g), very low birthweight was associated with a greater risk for developing asthma. Finally, the contribution of intrauterine factors (such as nutrition) in the development of asthma is receiving increasing attention in the scientific literature. Controlling for possible confounding factors is essential to clarifying the relationship between birthweight and asthma.

Prevalence and risk factors for chronic obstructive pulmonary disease according to symptoms and spirometry.

The burden of COPD is quite high and its prevalence is increasing. Few data are available from Latin America. There is no consensus on what criteria should be the gold standard for the definition of this disease. A population-based study was carried out in a southern Brazilian city, including adults aged 40-69 years. The aim was to measure the prevalence of COPD according to several criteria. From the 1,046 subjects chosen from a multiple-stage sampling protocol, a sub-sample of 234 subjects was systematically selected to undergo spirometry. Percentages of COPD according to different criteria were: chronic bronchitis by questionnaire (7.8%); GOLD stage 0 (7.3%); fixed ratio (15.2%); GOLD stage II (9.9%); ERS (27.7%). The relationship among the three lung functional measurements showed that around 70% of all subjects had negative results with all three criteria, and around 10% were positive according to all three. Utilization of symptom-based or spirometry definitions of COPD provide different prevalence estimates. Use of different spirometric criteria also resulted in different percentages of COPD. According to spirometry, COPD was higher among men, elderly, those with low education and ex-smokers. On the other hand, current smokers were more likely to present symptoms of chronic bronchitis. The fixed ratio criterion is recommended when population-specific reference curves are not available, while the GOLD definition is recommended to evaluate severity of COPD.

[Prevalence of and risk factors for cigarette smoking among adolescents in South America: a systematic literature review]. / Prevalência e fatores de risco para tabagismo em adolescentes na América do Sul: uma revisão sistemática da literatura.

OBJECTIVE: To describe the prevalence of teenage smoking and the factors associated with smoking in this age group in South America. METHODS: Searches for articles concerning teenage smoking in Latin America were conducted in two bibliographic databases: MEDLINE (1966-2002) and Latin American and Caribbean Literature on the Health Sciences ("LILACS") (1982-2002). We also reviewed governmental and nongovernmental documents and Web sites. From the 315 articles that we identified, we considered 45 to be relevant for this paper. RESULTS: In each of the countries that we studied, there was often a wide range found in prevalence levels, depending in part on the particular age range studied and on the definition of smokers that was used. The leading risk factor for teenage smoking was smoking among siblings and friends. Additional risk factors were poor academic performance, being older, male gender, having paid work, and having parents who were separated. CONCLUSIONS: Additional population-based studies with teenagers should be carried out, and more uniform criteria for defining smokers should be developed.