Late entry into HIV care: lessons from Brazil, 2003 to 2006.

BACKGROUND: To ascertain the population rates and proportion of late entry into HIV care, as well as to determine whether such late entry correlates with individual and contextual factors. METHODS: Data for the 2003-2006 period in Brazil were obtained from public health records. A case of late entry into HIV care was defined as one in which HIV infection was diagnosed at death, one in which HIV infection was diagnosed after the condition of the patient had already been aggravated by AIDS-related diseases, or one in which the CD4(+) T-cell count was ≤ 200 cells/mm(3) at the time of diagnosis. We also considered extended and stricter sets of criteria (in which the final criterion was ≤ 350 cells/mm(3) and ≤ 100 cells/mm(3), respectively). The estimated risk ratio was used in assessing the effects of correlates, and the population rates (per 100,000 population) were calculated on an annual basis. RESULTS: Records of 115,369 HIV-infected adults were retrieved, and 43.6% (50,358) met the standard criteria for late entry into care. Diagnosis at death accounted for 29% (14,457) of these cases. Late entry into HIV care (standard criterion) was associated with certain individual factors (sex, age, and transmission category) and contextual factors (region with less economic development/increasing incidence of AIDS, lower local HIV testing rate, and smaller municipal population). Use of the extended criteria increased the proportion of late entry by 34% but did not substantially alter the correlations analyzed. The overall population rate of late entry was 9.9/100,000 population, specific rates being highest for individuals in the 30-59 year age bracket, for men, and for individuals living in regions with greater economic development/higher HIV testing rates, collectively accounting for more than half of the cases observed. CONCLUSIONS: Although the high proportion of late entry might contribute to spreading the AIDS epidemic in less developed regions, most cases occurred in large cities, with broader availability of HIV testing, and in economically developed regions.

Tooth loss in Brazilian middle-aged adults: multilevel effects.

OBJECTIVE: To examine the link between tooth loss and multilevel factors in a national sample of middle-aged adults in Brazil. MATERIAL AND METHODS: Analyses were based on the 2003 cross-sectional national epidemiological survey of the oral health of the Brazilian population, which covered 13 431 individuals (age 35-44 years). Multistage cluster sampling was used. The dependent variable was tooth loss and the independent variables were classified according to the individual or contextual level. A multilevel negative binomial regression model was adopted. RESULTS: The average tooth loss was 14 (standard deviation 9.5) teeth. Half of the individuals had lost 12 teeth. The contextual variables showed independent effects on tooth loss. It was found that having 9 years or more of schooling was associated with protection against tooth loss (means ratio range 0.68-0.76). Not having visited the dentist and not having visited in the last > or =3 years accounted for increases of 33.5% and 21.3%, respectively, in the risk of tooth loss (P < 0.05). The increase in tooth extraction ratio showed a strong contextual effect on increased risk of tooth loss, besides changing the effect of protective variables. CONCLUSIONS: Tooth loss in middle-aged adults has important associations with social determinants of health. This study points to the importance of the social context as the main cause of oral health injuries suffered by most middle-aged Brazilian adults.

[Evaluation of the usefulness of assessing pulmonary aspiration in a gastroesophageal reflux scintigraphy study]. / Análise da utilidade da pesquisa de aspiração pulmonar no exame de cintilografia para a avaliação de refluxo gastroesofágico.

OBJECTIVE: To evaluate the benefit of routine pulmonary imaging with a five hour delay in gastroesophageal reflux scintigraphy (GERS) to detect pulmonary aspiration. METHODS: 755 cases were analyzed (400 men, 355 women) within a wide range of age (1 month up to 94 years, mean of 5.2 years). Presence of reflux, its frequency, severity, and esophageal extension were investigated. Delayed pulmonary images assessed the presence of radioactivity in the lungs. RESULTS: 307 cases of gastroesophageal reflux were identified, 84 of which with just one episode, 51 with 2 episodes, 45 with 3, 37 with 4, 18 with 5, and 72 with more than 5. Concerning severity of these 307 cases 22 had no evaluation, 179 were mild, 69 intermediate, and 37 severe. Degree of esophageal extension was not recorded for 6 cases; in 46 cases reflux covered the lower third of the esophagus, in 83 cases it reached the central third, in 161 the upper third, and in 11 cases it extended to the mouth. Delayed pulmonary images were available in 753 cases and none showed signs of lung aspiration. CONCLUSIONS: Delayed pulmonary images were negative in all cases regardless of the patients' age or severity of the disease. This is suggestive that either lung aspiration is rare in GERS procedures or delayed pulmonary imaging has a sensitivity that is too low to permit detection.

[Revista de Saúde Pública: forty years of Brazilian scientific production]. / Revista de Saúde Pública: quarenta anos da produção científica no Brasil.

OBJECTIVE: To recognize the characteristics and path taken by the through analysis of the scientific production it has published over the period from 1967 to 2005. METHODS: Scientometric methods were used to analyze reference data on the articles published in the Revista, retrieved from the databases ISI/Thomson Scientific (Web of Science), National Library of Medicine (PubMed) and Scientific Electronic Library Online (SciELO). RESULTS: The Revista is the only Brazilian publication in the field of public health that is indexed by ISI/Thomson Scientific. It is prominent as a medium for publishing Brazilian scientific production in public health and is displaying a geometric increase in publication and citation, with annual rates of 4.4% and 12.7%, respectively. The mean number of authors per paper has risen from 2 to 3.5 over recent years. Although original research articles predominate, the numbers of reviews, multicenter studies, clinical trials and validation studies have been increasing. The number of articles published in foreign languages has also increased, accounting for 13% of the total, and the leading countries originating these are the UK, USA, Argentina and Mexico. The number and diversity of journals citing the Journal has been increasing, many of which are non-Brazilian. Authorship per author shows good fit to Lotka's Law, but the parameters suggest greater concentration and less dispersion than would be expected. Among the fields of interest of published papers, the following topics account for more than 50% of the total volume: infectious-parasitic diseases and vectors; health promotion, policies and administration; and epidemiology, surveillance and disease control. CONCLUSIONS: The Revista shows great dynamism, without signs of abating or reaching a plateau any time soon. There are signs of progressively increasing complexity in the studies published, and more multidisciplinary work. The Revista seems to be widening its outreach and recognition, while remaining faithful to the field of public health in Brazil.

[Fuzzy logic and logistic regression in the decision making for parathyroid scintigraphy study]. / Lógica fuzzy e regressão logística na decisão para prática de cintilografia das paratiróides.

OBJECTIVE: To develop and compare two mathematical models, the first one based on logistic regression and the second one on fuzzy sets theory, aiming at defining a laboratory testing-based measure of indication for submitting patients to parathyroid scintigraphy. METHODS: One-hundred and ninety-four patients with serum calcium and parathyroid hormone available were identified from the data registry of parathyroid scintigraphy of a diagnostic laboratory in São Paulo, Southern Brazil, in the period between January 2000 and December 2004. The logistic regression model was developed using SPSS and the fuzzy model was developed using MatLab software programs. The performances of both models were compared using ROC curves. RESULTS: The performance of both models were statistically different (p=0.026). The area under the ROC curves were 0.862 (95% CI: 0.811-0.913) for the logistic regression model and 0.887 (95% CI: 0.840-0.933) for the fuzzy model. The latter had the advantage of allowing to making decisions based on parathyroid hormone information within a non-discriminating range of calcium values. CONCLUSIONS: The mathematical model based on fuzzy sets theory seemed to be more useful than the logistic model in the decision making for scintigraphy indication. However, inferences can be made only regarding model comparison and not for parathyroid scintigraphy itself since the data analyzed was not representative of any population.

The psychopathological factors of refractory schizophrenia.

OBJECTIVES: The heterogeneity of clinical manifestations in schizophrenia has lead to the study of symptom clusters through psychopathological assessment scales. The objective of this study was to elucidate clusters of symptoms in patients with refractory schizophrenia which may also help to assess the patients' therapeutical response. METHODS: Ninety-six treatment resistant patients were evaluated by the anchored version Brief Psychiatric Rating Scale (BPRS-A) as translated into Portuguese. The inter-rater reliability was 0.80. The 18 items of the BPRS-A were subjected to exploratory factor analysis with Varimax rotation. RESULTS: Four factors were obtained: Negative/Disorganization, composed by emotional withdrawal, disorientation, blunted affect, mannerisms/posturing, and conceptual disorganization; Excitement, composed of excitement, hostility, tension, grandiosity, and uncooperativeness, grouped variables that evoke brain excitement or a manic-like syndrome; Positive, composed of unusual thought content, suspiciousness, and hallucinatory behavior; and Depressive, composed of depressive mood, guilt feelings, and motor retardation, clearly related to depressive syndrome. CONCLUSIONS: The study reproduced the four factors described in the literature, either in refractory or non-refractory patients. The BPRS-A allowed the distinction of psychopathological factors, which are important in the evaluation of treatment response of patients with schizophrenia.

[The color of death: causes of death according to race in the State of Sao Paulo, 1999 to 2001]. / A cor da morte: causas de óbito segundo características de raça no Estado de São Paulo, 1999 a 2001.

OBJECTIVE: Assuming that ethnicity might be a basis for social differentiation and that such differences might represent vulnerability to sickness, this study attempts to verify whether race or ethnic origin have an effect on mortality patterns. METHODS: The Sao Paulo State death register was examined from 1999 to 2001 in a contingence table of causes according to the 10th ICD and race or skin-color categories (White, Black, Mulatto and others). Chi-square test was used to check the association between skin-color and cause of death; residual analysis was used to elicit statistically significant excessive occurrences when each category of cause of death and skin color was combined; and correspondence analysis was used to examine overall relations among all categories considered. RESULTS: A total of 647,321 valid death registers were analyzed, among which 77.7% were of Whites, 5.4% of Blacks, 14.3% of Mulattoes and 2.6% of others. A significant association between skin color or race and cause of death was found. It may be observed that, although Blacks and Mulattoes present a similar death profile, on the contrary of Whites and others, which could be aggregated into a single category, the former appear in distinct positions on the multidimensional map presented. Except for mal defined causes, which characterize only the deaths of Blacks, the other causes of death within this group are common to both Blacks and Mulattoes, varying however, in intensity and as to the order in which they appear death. CONCLUSIONS: Analysis of mortality according to race or color revealed that death has a color. There is a White death, which has, among its causes, sicknesses, which, although variable, are nothing more than sicknesses. There's a Black death, which is not caused by sicknesses but by external causes, complications in labor and delivery, mental disorders and ill-defined causes.

[National Health Innovation System: relations between scientific fields and economic sectors]. / Sistema Nacional de Inovação em Saúde: relações entre áreas da ciência e setores econômicos.

Health Science and Technology is currently the subject matter of government and university actions. Such actions should converge to the establishment of a National Health Innovation System, which still calls for acknowledgment from the economic sector counterpart. A study was carried out with the purpose of describing the relations between scientific fields and economic sectors as a means of learning more about this System. Records from the Brazilian Directory of Research Groups (version 4.1) were examined and selected when Health was a keyword either to field of knowledge or economic sector. Data were compiled into multiresponse variables and analyzed in contingency tables using residual, correspondence, and cluster analyses. It was found that the Brazilian National Health Innovation System constitutes a sectorial system where competitiveness is more socially than economically-oriented, making this System favorably in tandem with the National Unified Health System as well as responsive to public policies focused on social welfare.

Respiratory diseases and associated factors: population-based study in São Paulo, 2008-2009.

OBJECTIVE: To assess the prevalence of acute bronchitis, rhinitis, and sinusitis among children and adolescents and identify associated factors. METHODS: This is a population-based, cross-sectional study. A household survey was conducted with 1,185 children and adolescents from the city of São Paulo (Southeastern Brazil), from 2008 to 2009. The participants were selected by means of probability sampling, stratified by sex and age, and by two-stage cluster sampling. For the adjusted analysis, multiple Poisson regression was used. RESULTS: Of the respondents, 7.3% reported acute bronchitis, 22.6% rhinitis and 15.3% sinusitis. After the adjusted analysis, the following characteristics were associated with self;reported acute bronchitis: age 0 to 4 years (PR=17.86; 95%CI: 3.65;90.91), 5 to 9 years (PR=37.04; 95%CI: 8.13;166.67), 10 to 14 years (PR=20,83; 95%CI: 4.93;90.91), allergy (PR=3.12; 95%CI: 1.70;5.73), black and mixed-ethnicity (black and white) skin color (PR=2.29; 95%CI: 1.21;4.35), and living in a household with 1 to 3 rooms (PR=1.85; 95%CI: 1.17;2.94). As to self-reported rhinitis, the following characteristics were associated: age 10 to 14 years (PR=2.77; 95%CI: 1.60;4.78), 15 to 19 years (PR=2.58; 95%CI: 1.52;4.39), allergy (PR=4.32; 95%CI: 2.79;6.70), asthma (PR=2.30; 95%CI: 1.30;4.10) and living in flats (PR=1.70; 95%CI: 1.06;2.73). Concerning self-reported sinusitis, the following characteristics were associated: age 5 to 9 years (PR=2.44; 95%CI: 1.09;5.43), 10 to 14 years (PR=2.99; 95%CI: 1.36;6.58), 15 to 19 years (PR=3.62; 95%CI: 1.68;7.81), allergy (PR=2.23 (95%CI: 1.41;3.52) and obesity (PR=4.42; 95%CI: 1.56;12.50). CONCLUSIONS: Respiratory diseases were more prevalent in population groups with defined characteristics, such as age group, self-reported diseases, type of household and obesity.

[Prevalence of asthma and risk factors associated: population based study in São Paulo, Southeastern Brazil, 2008-2009]. / Prevalência de asma e fatores associados: estudo de base populacional em São Paulo, SP, 2008-2009.

OBJECTIVE: To assess the prevalence of asthma and risk factors associated in children and adolescents. METHODS: Population-based cross-sectional study with 1,185 female and male children and adolescents carried out in the city of São Paulo, Southeastern Brazil, from 2008 to 2009. Data were collected through home interviews. Respondents were selected from two-stage (census tract, household) cluster random sampling stratified by gender and age. Multiple Poisson regression was used in the adjusted analysis between the outcome and socioeconomic, demographic, lifestyle and health condition variables. RESULTS: Of all respondents, 9.1% (95%CI 7.0;11.7) reported asthma. After adjustment, the following variables were found independently associated with asthma: age (0 to 4 years vs. 15 to 19) (PR 3.18, 95%CI 1.20;8.42); age (5 to 9 years vs. 15 to 19) (PR 6.37, 95%CI 2.64;15.39); age (10 to 14 years vs. 15 to 19) (PR 4.51, 95%CI 1.95;10.40); allergy (yes vs. no) (PR 2.22, 95%CI 1.24;4.00); rhinitis (yes vs. no) (PR 2.13, 95%CI 1.22;3.73); health conditions in the 15 days preceding the interview (yes vs. no) (PR 1.96, 95%CI 1.23;3.11); number of rooms in the household (1 to 3 vs. 4 and more) (PR 1.67, 95%CI 1.05;2.66); and skin color (black and mixed vs. white) (PR 2.00, 95%CI 1.14;3.49). CONCLUSIONS: This study showed the importance of factors associated with asthma including rhinitis and allergy; age between 5 to 9 years old; black and mixed skin color; and household with few rooms. Frequent health problems are seen as a common consequence of asthma.

H-index of Collective Health professors in Brazil.

OBJECTIVE: To estimate reference values and the hierarchy function of professors engaged in Collective Health in Brazil by analyzing the distribution of the h-index. METHODS: From the Portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Portal of Coordination for the Improvement of Higher Education Personnel ), 934 authors were identified in 2008, of whom 819 were analyzed. The h-index of each professor was obtained through the Web of Science using search algorithms controlling for namesakes and alternative spellings of their names. For each Brazilian region and for the country as a whole, we adjusted an exponential probability density function to provide the population parameters and rate of decline by region. Ranking measures were identified using the complement of the cumulative probability function and the hierarchy function among authors according to the h-index by region. RESULTS: Among the professors analyzed, 29.8% had no citation record in Web of Science (h=0). The mean h for the country was 3.1, and the region with greatest mean was the southern region (h=4.7). The median h for the country was 3.1, and the greatest median was for the southern region (3.2). Standardizing populations to one hundred, the first rank in the country was h=16, but stratification by region shows that, within the northeastern, southeastern and southern regions, a greater value is necessary for achieving the first rank. In the southern region, the index needed to achieve the first rank was h=24. CONCLUSIONS: Most of the Brazilian Collective Health authors, if assessed on the basis of the Web of Science h-index, did not exceed h=5. Regional differences exist, with the southeastern and northeastern regions being similar and the southern region being outstanding.

Pertussis booster vaccine for adolescents and young adults in São Paulo, Brazil.

OBJECTIVE: To develop a model to assess different strategies of pertussis booster vaccination in the city of São Paulo. METHODS: A dynamic stationary age-dependent compartmental model with waning immunity was developed. The "Who Acquires Infection from Whom" matrix was used to modeling age-dependent transmission rates. There were tested different strategies including vaccine boosters to the current vaccination schedule and three of them were reported: (i) 35% coverage at age 12, or (ii) 70% coverage at age 12, and (iii) 35% coverage at age 12 and 70% coverage at age 20 at the same time. RESULTS: The strategy (i) achieved a 59% reduction of pertussis occurrence and a 53% reduction in infants while strategy (ii) produced 76% and 63% reduction and strategy (iii) 62% and 54%, respectively. CONCLUSION: Pertussis booster vaccination at age 12 proved to be the best strategy among those tested in this study as it achieves the highest overall reduction and the greatest impact among infants who are more susceptible to pertussis complications.

[Patterns of antiretroviral therapy adoption by the Brazilian public health system]. / Padrão de incorporação de fármacos antiretrovirais pelo sistema público de saúde no Brasil.

OBJECTIVE: The aim of the present scientific study is to evaluate the patterns of antiretroviral technology adoption by the Brazilian Public Health System (SUS). METHODS: Based on previous articles published in scientific medical literature, three indicators to assess antiretroviral technology adoption by SUS were proposed: knowledge-adoption interval; critical mass of knowledge; and validation-adoption interval. Using the databases from the SUS Department of Information Technology (DATASUS) and from the Brazilian Logistic Center for Medication Control (SICLOM), two pharmaceutical groups were selected (antiretroviral medications and a group of high cost medications). RESULTS: Antiretroviral medications were adopted faster than the high cost medication group when assessed on the basis of "knowledge-adoption" interval and "validation-adoption" interval. Yet, they require a lower "critical mass of knowledge" before adoption. CONCLUSION: Antiretroviral medications have been adopted faster and based on a lower number of scientific medical articles than a selected group of high cost medications.

Prevalence of chronic obstructive pulmonary disease and risk factors in São Paulo, Brazil, 2008-2009.

OBJECTIVE: To assess the prevalence of chronic obstructive pulmonary disease and related risk factors. METHODS: A population-based cross-sectional study with 1,441 individuals of both sexes aged 40 years or more was conducted in the city of São Paulo, Brazil, between 2008 and 2009. A two-stage (census tract, household) cluster random sampling stratified by sex and age was used and data was collected through home interviews. Multiple Poisson regression was used in the adjusted analysis. RESULTS: Of all respondents, 4.2% (95%CI: 3.1;5.4) reported chronic obstructive pulmonary disease. After adjustment the following factors were found independently associated with self-reported chronic obstructive pulmonary disease: number of cigarettes smoked in their lifetime (>1,500 vs. none) (PR=3.85; 95%CI: 1.87;7.94); easily fatigued (yes vs. no) (PR=2.61; 95%CI: 1.39;4.90); age (60;69 vs. 50;59) (PR 3.27; 95%CI: 1.01;11.24); age (70 and over vs. 50;59) (PR 4.29; 95%CI: 1.30;11.29); health conditions in the last 15 days (yes vs. no) (PR=1.31; 95%CI: 1.02;1.77); leisure-time physical activity (yes vs. no) (PR=0.57; 95%CI: 0.26;0.97). CONCLUSIONS: The prevalence of chronic obstructive pulmonary disease is high in the population studied and is associated with smoking and age over 60. Frequent health conditions and low leisure-time physical activity are a consequence of the disease.

Ponseti Brasil: a national program to eradicate neglected clubfoot - preliminary results.

BACKGROUND: After hearing about the reproducible and excellent results of the Ponseti method for clubfoot treatment, a group of Brazilian orthopaedic surgeons organized and participated in a standardized national program to teach the Ponseti technique in 21 different cities across Brazil. METHODS: A total of 21 Ponseti symposiums were organized in a standard fashion from January, 2007 to December, 2008. They consisted of a two-day program with lectures, hands-on cast application, and discussion of local clinical cases presented by orthopaedic surgeons. Thirteen Brazilian orthopaedic surgeons, who had been trained by the University of Iowa or centers recognized by them, taught the method. Financial support for travel was provided by an English charity: La Vida (Vital Investment for Developing Aid in Latin America). The physicians who attended the symposiums answered questionnaires before and after the training. RESULTS: About 7% of the 8000 orthopaedic surgeons in Brazil (556 orthopaedic surgeons) were trained. These orthopaedic surgeons stated that they had treated about 4905 babies in the previous year via other methods, including extensive surgery. Seventeen percent of the surgeons did not know about the Ponseti technique at the start of the symposium. Eighty-eight percent reported they felt able to treat children with the Ponseti technique after the symposium. Ninety-four percent of respondents reported that the symposium changed their way of treating clubfoot CONCLUSIONS: These Ponseti symposiums brought about an exchange of medical information and empowered the participants. This program is a good educational tool which can be used in eradicating neglected clubfoot in Brazil.

Late entry into HIV care: lessons from Brazil, 2003 to 2006

Background: To ascertain the population rates and proportion of late entry into HIV care, as well as to determine whether such late entry correlates with individual and contextual factors. Methods: Data for the 2003­2006 period in Brazil were obtained from public health records. A case of late entry into HIV care was defined as one in which HIV infection was diagnosed at death, one in which HIV infection was diagnosed after the condition of the patient had already been aggravated by AIDS-related diseases, or one in which the CD4+ T-cell count was ≤ 200 cells/mm3 at the time of diagnosis. We also considered extended and stricter sets of criteria (in which the final criterion was ≤ 350 cells/mm3 and ≤ 100 cells/mm3 , respectively). The estimated risk ratio was used in assessing the effects of correlates, and the population rates (per 100,000 population) were calculated on an annual basis. Results: Records of 115,369 HIV-infected adults were retrieved, and 43.6% (50,358) met the standard criteria for late entry into care. Diagnosis at death accounted for 29% (14,457) of these cases. Late entry into HIV care (standard criterion) was associated with certain individual factors (sex, age, and transmission category) and contextual factors (region with less economic development/increasing incidence of AIDS, lower local HIV testing rate, and smaller municipal population). Use of the extended criteria increased the proportion of late entry by 34% but did not substantially alter the correlations analyzed. The overall population rate of late entry was 9.9/100,000 population, specific rates being highest for individuals in the 30­59 year age bracket, for men, and for individuals living in regions with greater economic development/higher HIV testing rates, collectively accounting for more than half of the cases observed. Conclusions: Although the high proportion of late entry might contribute to spreading the AIDS epidemic in less developed regions, most cases occurred in large cities, with broader availability of HIV testing, and in economically developed regions.

Doenças respiratórias e fatores associados: estudo de base populacional em São Paulo, 2008-2009 / Respiratory diseases and associated factors: population-based study in São Paulo, 2008-2009 / Enfermedades respiratorias y factores asociados: estudio de base poblacional en Sao Paulo (Sureste de Brasil), 2008-2009

OBJETIVO: Estimar a prevalência de bronquite aguda, rinite e sinusite em crianças e adolescentes e identificar fatores associados. MÉTODOS: Estudo transversal, de base populacional. Foi realizado inquérito domiciliar com 1.185 crianças e adolescentes de São Paulo, SP, de 2008 a 2009. Os participantes foram selecionados a partir de amostragem probabilística, estratificada por sexo e idade e por conglomerados em dois estágios. Para análise ajustada foi realizada regressão múltipla de Poisson. RESULTADOS: Dos entrevistados, 7,3 por cento referiram bronquite aguda, 22,6 por cento rinite e 15,3 por cento sinusite. Após análise ajustada, associaram-se à bronquite aguda auto-referida: idade de zero a quatro anos (RP = 17,86; IC95 por cento: 3,65;90,91), cinco a nove anos (RP = 37,04; IC95 por cento: 8,13;166,67), dez a 14 anos (RP = 20,83; IC95 por cento: 4,93;90,91), referir ter alergia (RP = 3,12; IC95 por cento: 1,70;5,73), cor da pele preta/parda (RP = 2,29; IC95 por cento: 1,21;4,35) e morar em domicílio com um a três cômodos (RP = 1,85; IC95 por cento: 1,17;2,94); à rinite auto-referida: idade dez a 14 anos (RP = 2,77; IC95 por cento: 1,60;4,78), 15 a 19 anos (RP = 2,58; IC95 por cento: 1,52;4,39), referir ter alergia (RP = 4,32; IC95 por cento: 2,79;6,70), referir ter asma (RP = 2,30; IC95 por cento: 1,30;4,10) e morar em apartamento (RP = 1,70; IC95 por cento: 1,06;2,73); à sinusite auto-referida: idade cinco a nove anos (RP = 2,44; IC95 por cento: 1,09;5,43), dez a 14 anos (RP = 2,99; IC95 por cento: 1,36;6,58), 15 a 19 anos (RP = 3,62; IC95 por cento: 1,68;7,81), referir ter alergia (RP = 2,23; IC95 por cento: 1,41;3,52) e apresentar obesidade (RP = 4,42; IC95 por cento: 1,56;12,50). CONCLUSÕES: As doenças respiratórias foram mais prevalentes em grupos populacionais com características definidas, como grupo etário, doenças auto-referidas, tipo de moradia e obesidade.

OBJECTIVE: To assess the prevalence of acute bronchitis, rhinitis, and sinusitis among children and adolescents and identify associated factors. METHODS: This is a population-based, cross-sectional study. A household survey was conducted with 1,185 children and adolescents from the city of São Paulo (Southeastern Brazil), from 2008 to 2009. The participants were selected by means of probability sampling, stratified by sex and age, and by two-stage cluster sampling. For the adjusted analysis, multiple Poisson regression was used. RESULTS: Of the respondents, 7.3 percent reported acute bronchitis, 22.6 percent rhinitis and15.3 percent sinusitis. After the adjusted analysis, the following characteristics were associated with self;reported acute bronchitis: age 0 to 4 years (PR=17.86; 95 percentCI: 3.65;90.91), 5 to 9 years (PR=37.04; 95 percentCI: 8.13;166.67), 10 to 14 years (PR=20,83; 95 percentCI: 4.93;90.91), allergy (PR=3.12; 95 percentCI: 1.70;5.73), black and mixed-ethnicity (black and white) skin color (PR=2.29; 95 percentCI: 1.21;4.35), and living in a household with 1 to 3 rooms (PR=1.85; 95 percentCI: 1.17;2.94). As to self-reported rhinitis, the following characteristics were associated: age 10 to 14 years (PR=2.77; 95 percentCI: 1.60;4.78), 15 to 19 years (PR=2.58; 95 percentCI: 1.52;4.39), allergy (PR=4.32; 95 percentCI: 2.79;6.70), asthma (PR=2.30; 95 percentCI: 1.30;4.10) and living in flats (PR=1.70; 95 percentCI: 1.06;2.73). Concerning self-reported sinusitis, the following characteristics were associated: age 5 to 9 years (PR=2.44; 95 percentCI: 1.09;5.43), 10 to 14 years (PR=2.99; 95 percentCI: 1.36;6.58), 15 to 19 years (PR=3.62; 95 percentCI: 1.68;7.81), allergy (PR=2.23 (95 percentCI: 1.41;3.52) and obesity (PR=4.42; 95 percentCI: 1.56;12.50). CONCLUSIONS: Respiratory diseases were more prevalent in population groups with defined characteristics, such as age group, self-reported diseases, type of household and obesity.

OBJETIVO: Estimar la prevalencia de bronquitis aguda, rinitis y sinusitis en niños y adolescentes e identificar factores asociados. MÉTODOS: Estudio transversal, de base poblacional. Se realizó pesquisa domiciliar con 1.185 niños y adolescentes de Sao Paulo (Sureste de Brasil), de 2008 a 2009. Los participantes fueron seleccionados a partir de muestreo probabilístico, estratificado por sexo y edad y por conglomerados en dos fases. Para análisis ajustado fue realizada regresión múltiple de Poisson. RESULTADOS: De los entrevistados, 7,3 por ciento narraron bronquitis aguda, 22,6 por ciento rinitis y 15,3 por ciento sinusitis. Posterior al análisis ajustado, se asociaron la bronquitis aguda auto-referida: edad de cero a cuatro años (RP=17,86; IC95 por ciento:3,65;90,91), cinco a nueve años (RP=37,04; IC95 por ciento:8,13;166,67), diez a 14 años (RP=20,83; IC95 por ciento: 4,93;90,91), relatar presencia de alergia (RP=3,12; IC95 por ciento: 1,70;5,73), color de la piel negra/parda (RP=2,29; IC95 por ciento: 1,21;4,35) y vivir en domicilio con uno a tres cuartos (RP=1,85; IC95 por ciento:1,17;2,94); a la rinitis auto-referida: edad de diez a 14 años (RP=2,77; IC95 por ciento:1,60;4,78), 15 a 19 años (RP=2,58; IC95 por ciento:1,52;4,39), relatar presencia de alergia (RP=4,32; IC95 por ciento: 2,79;6,70), relatar presencia de asma (RP= 2,30; IC95 por ciento:1,30;4,10) y vivir en apartamento (RP=1,70; IC95 por ciento:1,06;2,73); a la sinusitis auto-referida: edad de cinco a nueve años (RP=2,44; IC95 por ciento: 1,09;5,43), diez a 14 años (RP=2,99; IC95 por ciento: 1,36;6,58), 15 a 19 años (RP=3,62; IC95 por ciento: 1,68;7,81), relatar presencia de alergia (RP=2,23; IC95 por ciento: 1,41;3,52) y presentar obesidad (RP=4,42; IC95 por ciento: 1,56;12,50). CONCLUSIONES: Las enfermedades respiratorias prevalecieron mayormente en grupos poblacionales con características definidas, como grupo de edad, enfermedades auto-referidas, tipo de vivienda y obesidad.

Prevalência de asma e fatores associados: estudo de base populacional em São Paulo, SP, 2008-2009 / Prevalence of asthma and risk factors associated: population based study in São Paulo, Southeastern Brazil, 2008-2009 / Prevalencia de asma y factores asociados: estudio de base poblacional en Sao Paulo, Sudeste de Brasil, 2008-2009

OBJETIVO: Estimar a prevalência de asma em crianças e adolescentes e identificar fatores associados. MÉTODOS: Estudo transversal de base populacional com 1.185 crianças e adolescentes de ambos os sexos de São Paulo, SP, de 2008 a 2009. As informações foram coletadas por meio de entrevistas domiciliares e os participantes foram selecionados a partir de amostragem probabilística, estratificada por sexo e idade, e por conglomerados em dois estágios (setores censitários e domicílios). Foi realizada regressão múltipla de Poisson na análise ajustada entre o desfecho e variáveis sociodemográficas, econômicas, estilo de vida e condições de saúde. RESULTADOS: Dos entrevistados, 9,1% (IC95% 7,0;11,7) referiram asma. Após análise ajustada, identificaram-se os seguintes fatores independentemente associados ao agravo: idade (zero a quatro anos/15 a 19) RP = 3,18 (IC95% 1,20;8,42), idade (cinco a nove anos/15 a 19) RP = 6,37 (IC95% 2,64;15,39), idade (10 a 14 anos/15 a 19) RP = 4,51 (IC95% 1,95;10,40), alergia (sim/não) RP = 2,22 (IC95% 1,24;4,00), rinite (sim/não) RP = 2,13 (IC95% 1,22;3,73), problemas de saúde nos 15 dias prévios à entrevista (sim/não) RP = 1,96 (IC95% 1,23;3,11), número de cômodos no domicílio (1 a 3/4 e mais) RP = 1,67 (IC95% 1,05;2,66), e cor da pele (preta e parda/branca) RP = 2,00 (IC95% 1,14;3,49). CONCLUSÕES: Os achados do presente estudo apontam a importância da asma associada à presença de rinite e alergia, idade entre cinco e nove anos, cor da pele preta e parda e moradia com menor número de cômodos. Os frequentes problemas de saúde podem ser considerados consequência dessa doença.

OBJECTIVE: To assess the prevalence of asthma and risk factors associated in children and adolescents. METHODS: Population-based cross-sectional study with 1,185 female and male children and adolescents carried out in the city of São Paulo, Southeastern Brazil, from 2008 to 2009. Data were collected through home interviews. Respondents were selected from two-stage (census tract, household) cluster random sampling stratified by gender and age. Multiple Poisson regression was used in the adjusted analysis between the outcome and socioeconomic, demographic, lifestyle and health condition variables. RESULTS: Of all respondents, 9.1% (95%CI 7.0;11.7) reported asthma. After adjustment, the following variables were found independently associated with asthma: age (0 to 4 years vs. 15 to 19) (PR 3.18, 95%CI 1.20;8.42); age (5 to 9 years vs. 15 to 19) (PR 6.37, 95%CI 2.64;15.39); age (10 to 14 years vs. 15 to 19) (PR 4.51, 95%CI 1.95;10.40); allergy (yes vs. no) (PR 2.22, 95%CI 1.24;4.00); rhinitis (yes vs. no) (PR 2.13, 95%CI 1.22;3.73); health conditions in the 15 days preceding the interview (yes vs. no) (PR 1.96, 95%CI 1.23;3.11); number of rooms in the household (1 to 3 vs. 4 and more) (PR 1.67, 95%CI 1.05;2.66); and skin color (black and mixed vs. white) (PR 2.00, 95%CI 1.14;3.49). CONCLUSIONS: This study showed the importance of factors associated with asthma including rhinitis and allergy; age between 5 to 9 years old; black and mixed skin color; and household with few rooms. Frequent health problems are seen as a common consequence of asthma.

OBJETIVO: Estimar la prevalencia de asma en niños y adolescentes e identificar factores asociados. MÉTODOS: Estudio transversal de base poblacional con 1.185 niños y adolescentes de ambos sexos de Sao Paulo, Sudeste de Brasil, de 2008 a 2009. Las informaciones fueron colectadas por medio de entrevistas domiciliares y los participantes fueron seleccionados a partir de muestreo probabilístico, estratificado por sexo y edad, y por conglomerados en dos fases (sectores censitarios y domicilios). Se realizó regresión múltiple de Poisson en el análisis ajustado entre el resultado y las variables sociodemográficas, económicas, estilo de vida y condiciones de salud. RESULTADOS: De los entrevistados, 9,1% (IC95% 7,0;11,7) refirieron asma. Posterior al análisis ajustado, se identificaron los siguientes factores independientemente asociados al agravio: edad (cero a cuatro años/15 a 19) RP = 3,18 (IC95% 1,20;8,42), edad (cinco a nueve años/15 a 19) RP = 6,37 (IC95% 2,64;15,39), edad (10 a 14 años/15 a 19) RP = 4,51 (IC95% 1,95;10,40), alergia (si/no) RP = 2,22 (IC95% 1,24;4,00), rinitis (si/no) RP = 2,13 (IC95% 1,22;3,73), problemas de salud en los 15 días previos a la entrevista (si/no) RP = 1,96 (IC95% 1,23;3,11), número de cuartos en el domicilio (1 a 3/4 y más) RP = 1,67 (IC95% 1,05;2,66), y color de la piel (negra y parda/blanca) RP = 2,00 (IC95% 1,14;3,49). CONCLUSIONES: Los resultados del presente estudio señalan la importancia del asma asociada a la presencia de rinitis y alergia, edad entre cinco y nueve años, color de la piel negra y parda, y a la vivienda con menor número de cuartos. Los frecuentes problemas de salud pueden ser considerados consecuencia de esta enfermedad.

Association between risk factors for coronary artery disease and coronary disease in patients undergoing myocardial perfusion scintigraphy.

OBJECTIVES: To establish the degree of association between cardiovascular risk factors and the presence of coronary artery disease (CAD) in a group of patients undergoing myocardial perfusion scintigraphy (MPS). METHODS: The study included 7183 patients who had undergone MPS. Using logistic regression analysis the odds ratios for the following risk factors were evaluated: age, gender, family history, body mass index, smoking, dyslipidemia, diabetes mellitus (DM) and systemic hypertension. Indicators for the presence of CAD were defined as: myocardial infarction, revascularization, angioplasty or an altered MPS. Analysis was based on the whole the group as well as on male and female subgroups. The impact of the risk factors in relation to age was also analyzed. RESULTS: A statistically significant association was observed between patient age and gender and the presence of CAD. For females, it was demonstrated that DM is the main modifiable risk factor for CAD. For males various modifiable risk factors were associated with the presence of CAD, particularly DM and dyslipidemia. In the analysis by age groups some risk factors showed a more expressive association. CONCLUSION: The main risk factors for CAD were aging and male gender. In relation to modifiable risk factors and the presence of CAD, the greatest associations for males were DM and dyslipidemia and for females DM. The most relevant factors for specific age groups were smoking for young men and DM and smoking for women between the ages of 40 and 50.

Índice h de docentes em Saúde Coletiva no Brasil / H-index of Collective Health professors in Brazil / Índice h de docentes en Salud Colectiva en Brasil

OBJETIVO: Estimar valores de referência e função de hierarquia de docentes em Saúde Coletiva do Brasil por meio de análise da distribuição do índice h. MÉTODOS: A partir do portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, 934 docentes foram identificados em 2008, dos quais 819 foram analisados. O índice h de cada docente foi obtido na Web of Science mediante algoritmos de busca com controle para homonímias e alternativas de grafia de nome. Para cada região e para o Brasil como um todo ajustou-se função densidade de probabilidade exponencial aos parâmetros média e taxa de decréscimo por região. Foram identificadas medidas de posição e, com o complemento da função probabilidade acumulada, função de hierarquia entre autores conforme o índice h por região. RESULTADOS: Dos docentes, 29,8 por cento não tinham qualquer registro de citação (h = 0). A média de h para o País foi 3,1, com maior média na região Sul (4,7). A mediana de h para o País foi 2,1, também com maior mediana na Sul (3,2). Para uma padronização de população de autores em cem, os primeiros colocados para o País devem ter h = 16; na estratificação por região, a primeira posição demanda valores mais altos no Nordeste, Sudeste e Sul, sendo nesta última h = 24. CONCLUSÕES: Avaliados pelos índices h da Web of Science, a maioria dos autores em Saúde Coletiva não supera h = 5. Há diferenças entres as regiões, com melhor desempenho para a Sul e valores semelhantes entre Sudeste e Nordeste.

OBJECTIVE: To estimate reference values and the hierarchy function of professors engaged in Collective Health in Brazil by analyzing the distribution of the h-index. METHODS: From the Portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Portal of Coordination for the Improvement of Higher Education Personnel ), 934 authors were identified in 2008, of whom 819 were analyzed. The h-index of each professor was obtained through the Web of Science using search algorithms controlling for namesakes and alternative spellings of their names. For each Brazilian region and for the country as a whole, we adjusted an exponential probability density function to provide the population parameters and rate of decline by region. Ranking measures were identified using the complement of the cumulative probability function and the hierarchy function among authors according to the h-index by region. RESULTS: Among the professors analyzed, 29.8 percent had no citation record in Web of Science (h=0). The mean h for the country was 3.1, and the region with greatest mean was the southern region (h=4.7). The median h for the country was 3.1, and the greatest median was for the southern region (3.2). Standardizing populations to one hundred, the first rank in the country was h=16, but stratification by region shows that, within the northeastern, southeastern and southern regions, a greater value is necessary for achieving the first rank. In the southern region, the index needed to achieve the first rank was h=24. CONCLUSIONS: Most of the Brazilian Collective Health authors, if assessed on the basis of the Web of Science h-index, did not exceed h=5. Regional differences exist, with the southeastern and northeastern regions being similar and the southern region being outstanding.

OBJETIVO: Estimar valores de referencia y función de jerarquía de docentes en Salud Colectiva de Brasil por medio de análisis de distribución del índice h. MÉTODOS: A partir del Portal de la Coordinación de Perfeccionamiento de Personal de Nivel Superior 934 docentes fueron identificados en 2008, de los cuales 819 fueron analizados. El índice h de cada docente fue obtenido en la Web of Science mediante algoritmos de búsqueda con control para homonimias y alternativas de grafía de nombre. Para cada región y para Brasil como un todo se ajustó función de densidad de probabilidad exponencial a los parámetros promedio y tasa de decrecimiento por región. Fueron identificadas medidas de posición y, con el complemento de la función probabilidad acumulada, función de jerarquía entre autores conforme el índice h por región. RESULTADOS: De los docentes, 29,8 por ciento no tenían registro alguno de citación (h=0). El promedio de h para Brasil fue 3,1, con mayor promedio en la región Sur (4,7). La mediana de h para el país fue 2,1, también con mayor mediana en el Sur (3,2). Para una estandarización de población de autores en cien, los primeros colocados para el país deben tener h=16; en la estratificación por región, la primera posición demanda valores más altos en el Noreste, Sureste y Sur, siendo en ésta última h=24. CONCLUSIONES: Evaluados por los índices h de la Web of Science, la mayoría de los autores en Salud Colectiva no supera h=5. Hay diferencias entre las regiones, con mejor desempeño para el Sur y valores semejantes entre Sureste y Noreste.