[Evaluation of coverage by family health teams for fatal stroke victims in Maringá, Paraná State, Brazil]. / Avaliação da cobertura assistencial das equipes de saúde da família às pessoas que faleceram por doenças cerebrovasculares em Maringá, Paraná, Brasil.

The work process in the Brazilian Family Health Program (FHP) allows teams to establish bonds, accept families, and take responsibility for the registered population and identify groups at risk. Monitoring allows problem surveying and evaluation of specific measures. Considering that a key objective of controlling arterial hypertension is to reduce stroke mortality, this study aimed to identify the coverage, follow-up, and quality of care for individuals in areas with the FHP who died of stroke, based on data from the family registries (Form A), follow-up (Form B), and patient records in primary health care units. The results showed low coverage, with 33.3% of registration on Form A, follow-up of 4.9% of deaths, and absence of any annotation on the care provided in most patient records (52.4%). Analysis of care in the group confirmed the fragmentation and disconnection between the different information systems. It is essential to encourage the use of available data and improve their recording in order to institutionalize evaluation practice and work organization from a health surveillance perspective.

[Living conditions and infant mortality in the State of Paraná, Brazil, 1997/2001]. / Condições de vida e mortalidade infantil no Estado do Paraná, Brasil, 1997/2001.

This objective of this paper was to verify the relations between the living and infrastructure conditions of municipalities in the State of Paraná, Brazil, and infant mortality rate and its components. An ecological study was carried out having the 399 municipalities of the State being classified into five clusters of living conditions. Infant, neonatal and postneonatal rates were calculated for the period 1997/2001. The mean infant, neonatal and postneonatal mortality rates in the State were, respectively, 19.3, 12.0 and 7.3 per 1,000 live births. Postneonatal mortality rates ranged from 8.7 (cluster of worst living conditions) to 6.3 per 1,000 live births (in the cluster classified as having the best living conditions). Regarding the neonatal component, clusters classified as holding the best and the worst living conditions presented the lowest values: 11.8 and 11.4 per 1,000 live births, respectively. We conclude that the postneonatal component still adequately discriminate living conditions in the State of Paraná. However, there is a need of complementary studies that aim to clarify the causes of similar neonatal mortality rates observed in the richest and in the poorest cluster of municipalities.

[Public sector participation in the supply of dyslipidemia medication in a population-based study]. / Participação do setor público no fornecimento de medicamentos para dislipidemias em estudo de base populacional.

The use of medications for the treatment of dyslipidemia is relevant in the control of cardiovascular disease. This article aims to analyze the prevalence, the use and the participation of the public sector in the supply of medication for adults aged 40 years and above using pharmacotherapy for dyslipidemia control living in a city in the southern region of Brazil. A cross-sectional, population-based study was conducted. Household interviews were staged with 1180 individuals aged over 40 living in Cambé, State of Paraná, of which 967 took laboratory examinations. The prevalence of dyslipidemia was 69.2%, of which 16.1% were taking medication. Among individuals undergoing treatment for dyslipidemia, 22.2% had adequate test results. Lipid-lowering medication used were simvastatin (81.5%) and bezafibrate (6.5%), mainly obtained by direct payment to private pharmacies and drug stores (52.2%) and NHS services (33.6%). A high prevalence of dyslipidemias was observed in population terms, together with a low level of dyslipidemia control and low participation of the public sector regarding the supply of medication compared to acquisition through direct payment for medication in private pharmacies. These results suggest a limited range of public policy for control of dyslipidemia.

[Assessment of the follow-up of adult patients with arterial hypertension and/or diabetes mellitus by the Family Health Strategy and identification of associated factors in the city of Cambé, Brazil, 2012]. / Avaliação do acompanhamento de pacientes adultos com hipertensão arterial e ou diabetes melito pela Estratégia Saúde da Família e identificação de fatores associados, Cambé-PR, Brasil, 2012.

OBJECTIVE: to assess the follow-up of adults with arterial hypertension and/or diabetes by the Family Health teams and identify associated factors in the city of Cambé-PR, Brazil, in 2012. METHODS: evaluation research using document analysis with calculation of the following indicators: coverage and concentration of household visits, medical consultation, and nursing consultation. RESULTS: 386 of the 687 individuals with hypertension or diabetes had records of their condition at the Primary Healthcare Units; medical consultation coverage (69.2%) was regular, while nursing consultation (1.5%) and household visit (12.2%) indices were critical; concentration was critical for household visits, nursing consultations, and medical consultations for high-risk groups; medical consultation coverage was higher among women, those with lower schooling, and those attending Primary Healthcare Units (p<0.05), but did not differ with regard to cardiovascular risk. CONCLUSION: follow-up by the teams does not meet the healthcare standard set for the programmatic groups analyzed.

Relationship between social capital indicators and lifestyle in Brazilian adults.

The present study examined the relationship between indicators of social capital and health-related behaviors. A cross-sectional study was conducted on a sample of 1,062 participants representative of the population aged 40 years or older from a city in Southern Brazil. The following indicators of social capital were examined: number of friends, number of people they could borrow money from when in need; extent of trust in community members; number of times members of the community help each other; community safety; and extent of membership in community activities. Also, an overall score of social capital including all indicators was calculated. A poor social capital was associated with insufficient leisure-time physical activity (OR = 1.70; 95%CI: 1.07-2.70), low consumption of fruits and vegetables (OR = 1.53; 95%CI: 1.05-2.24), and smoking (OR = 1.97; 95%CI: 1.21-3.21). No clear association was found between capital social and binge drinking. A score of social capital showed an inverse relationship with the number of prevalent risk behaviors (p < 0.001). These results reinforce that policies to promote health should consider social capital.

[Non-adherence to continuous treatment and associated factors: prevalence and determinants in adults 40 years and older]. / Não adesão ao tratamento medicamentoso contí nuo: prevalência e determinantes em adultos de 40 anos e mais.

This study investigates factors associated with non-adherence to continuous drug therapy in individuals 40 years and older. A population-based survey was conducted in Cambé, Paraná State, Brazil. Treatment adherence was assessed with the four-item Morisky et al. medication adherence scale. The study also assessed socio-demographic variables and health services access and use of medication. Among 1,180 interviewees, 78% reported use of medication, with continuous use in 55%. The study analyzed 639 individuals, the majority female, ranging from 40 to 59 years of age, with low schooling, and from socioeconomic stratum C (on a scale from A to E). Prevalence of non-adherence was 63.5%. Mean therapeutic complexity was 8.1. After adjusted analysis, the following factors remained associated with non-adherence: not being assisted by community health workers, discontinuous access to medication, and high frequency of medication throughout the day. The results indicate high prevalence of non-adherence, with potentially negative impacts for individuals and society.

[Demographic characteristics and mortality among indigenous peoples in Mato Grosso do Sul State, Brazil]. / Aspectos demográficos e mortalidade de populações indígenas do Estado do Mato Grosso do Sul, Brasil.

The present study aimed to assess mortality rates and related demographic factors among indigenous peoples in the State of Mato Grosso do Sul, Central-West Brazil, compared to the State's general population. Mortality rates were estimated based on data obtained from the Health Care Database for Indigenous Peoples and monthly patient care records as well as demographic data from the Brazilian Unified National Health System (SUS) and mortality data from the SUS Mortality Database. Compared to the overall population, among indigenous peoples there were proportionally more individuals under 15 years of age and fewer elderly, besides higher mortality rates at early ages and from infectious and parasitic diseases. Indigenous men showed significantly higher mortality rates from external causes and respiratory and infectious diseases, while among women the mortality rates from external causes and infectious diseases were higher. Suicide rates among young indigenous individuals were also particularly alarming. Indigenous people's health conditions are worse than those of the general population in Mato Grosso do Sul.

Participação do setor público no fornecimento de medicamentos para dislipidemias em estudo de base populacional / Public sector participation in the supply of dyslipidemia medication in a population-based study

Resumo A utilização de medicamentos para tratamento das dislipidemias é relevante no controle das doenças cardiovasculares. O objetivo deste artigo é analisar a prevalência, a utilização e a participação do setor público no fornecimento de medicamentos para as pessoas a partir de 40 anos em farmacoterapia de controle das dislipidemias, residentes em um município da região Sul do Brasil. Estudo transversal de base populacional. Foram entrevistados no domicilio 1180 indivíduos a partir de 40 anos residentes em Cambé/PR, dos quais 967 realizaram exames laboratoriais. A prevalência de dislipidemias foi de 69,2%, dos quais 16,1% utilizavam medicamentos. Entre os indivíduos em tratamento para as dislipidemias, 22,2% apresentaram resultados de exames adequados. Os fármacos hipolipemiantes mais utilizados foram sinvastatina (81,5%) e bezafibrato (6,5%), obtidos principalmente por pagamento direto em farmácias e drogarias privadas (52,2%) e serviços próprios do SUS (33,6%). Em nível populacional a prevalência das dislipidemias foi elevada, o seu controle baixo, com menor participação do setor público no fornecimento dos medicamentos do que a aquisição mediante pagamento direto em farmácias e drogarias privadas, sugerindo alcance limitado das políticas públicas de controle das dislipidemias.

Abstract The use of medications for the treatment of dyslipidemia is relevant in the control of cardiovascular disease. This article aims to analyze the prevalence, the use and the participation of the public sector in the supply of medication for adults aged 40 years and above using pharmacotherapy for dyslipidemia control living in a city in the southern region of Brazil. A cross-sectional, population-based study was conducted. Household interviews were staged with 1180 individuals aged over 40 living in Cambé, State of Paraná, of which 967 took laboratory examinations. The prevalence of dyslipidemia was 69.2%, of which 16.1% were taking medication. Among individuals undergoing treatment for dyslipidemia, 22.2% had adequate test results. Lipid-lowering medication used were simvastatin (81.5%) and bezafibrate (6.5%), mainly obtained by direct payment to private pharmacies and drug stores (52.2%) and NHS services (33.6%). A high prevalence of dyslipidemias was observed in population terms, together with a low level of dyslipidemia control and low participation of the public sector regarding the supply of medication compared to acquisition through direct payment for medication in private pharmacies. These results suggest a limited range of public policy for control of dyslipidemia.

Functional disability for mobility in adults: a population-based study / Incapacidade funcional para mobilidade em adultos: estudo de base populacional

Abstract Introduction: Functional disability is an important health indicator associated with worse quality of life. Objective: To estimate the prevalence of functional disability for mobility and to identify factors associated with difficulty going up and down stairs in adults aged 40 years or over. Methods: Cross-sectional, population-based study, with residents of the Municipality of Cambé, PR, interviewed in 2011. The dependent variable was the difficulty of going up and down stairs. Analysis of associated factors was performed using Poisson regression for each subgroup (40 - 59 years and 60 years or older). Results: In total, 24% of the subjects presented some kind of difficulty going up stairs (p < .01). In both subgroups, a significantly higher prevalence in women, among those inactive during leisure time and those with a history of cerebrovascular disease was observed. In the subgroup aged 40 to 59 years, age 50 - 59 years, hypertension, diabetes and falls in the previous 12 months were also associated with the outcome. Conclusion: The results suggest the need to expand the actions of health promotion, prevention and control of chronic conditions, especially among middle-aged people.

Resumo Introdução: A incapacidade funcional é importante indicador de saúde, associada a pior qualidade de vida. Objetivo: Estimar a prevalência de incapacidade funcional para mobilidade e identificar os fatores associados à dificuldade de subir e descer escadas em adultos de 40 anos ou mais. Metódos: Estudo transversal, de base populacional, com residentes no Município de Cambé-PR, entrevistados em 2011. A variável dependente foi a dificuldade de subir e descer escadas. A análise de fatores associados foi realizada por meio da regressão de Poisson, para cada subgrupo etário (40 a 59 anos e 60 anos ou mais). Resultados: No total, 24% referiram alguma dificuldade para subir e descer escadas (p < 0,01). Em ambos os subgrupos, observaram-se prevalências significativamente mais elevadas em mulheres, entre os inativos no lazer e naqueles com histórico de doença cerebrovascular. No subgrupo com idade entre 40 e 59 anos, associaram-se também ao desfecho a faixa etária de 50 a 59 anos, a hipertensão arterial, o diabetes e queda nos últimos 12 meses. Conclusão: Os resultados apontam a necessidade de ampliar as ações de promoção da saúde e de prevenção e controle das condições crônicas, principalmente entre não idosos.

Avaliação do acompanhamento de pacientes adultos com hipertensão arterial e ou diabetes melito pela Estratégia Saúde da Família e identificação de fatores associados, Cambé-PR, Brasil, 2012 / Assessment of the follow-up of adult patients with arterial hypertension and/or diabetes mellitus by the Family Health Strategy and identification of associated factors in the city of Cambé, Brazil, 2012 / Evaluación del acompañamiento de pacientes adultos con hipertensión arterial y/o diabetes mellitus por la Estrategíade Salud de la Familia e identificación de factores asociados. Cambé-PR, Brasil, 2012

OBJETIVO: avaliar o acompanhamento de adultos com hipertensão arterial e ou diabetes pelas equipes de Saúde da Família e identificar fatores associados, na cidade de Cambé-PR, Brasil, em 2012. MÉTODOS: pesquisa avaliativa de análise documental, calculando-se os indicadores de cobertura e concentração de visita domiciliar, consulta médica e de enfermagem. RESULTADOS: dos 687 indivíduos com hipertensão e ou diabetes, 386 tinham registro da condição nas unidades básicas; a cobertura de consulta médica (69,2%) foi regular, as de consulta de enfermagem (1,5%) e visita domiciliar (12,2%) foram críticas; a concentração revelou-se crítica em visitas domiciliares, consultas de enfermagem e consultas médicas aos grupos de alto risco; as coberturas de consulta médica foram mais elevadas em mulheres, indivíduos de menor escolaridade e que utilizavam unidades básicas de saúde (p < 0,05), sem distinção conforme o risco cardiovascular. CONCLUSÃO: o acompanhamento pelas equipes não atende ao padrão assistencial estabelecido para os grupos programáticos analisados.

OBJECTIVE: to assess the follow-up of adults with arterial hypertension and/or diabetes by the Family Health teams and identify associated factors in the city of Cambé-PR, Brazil, in 2012. METHODS: evaluation research using document analysis with calculation of the following indicators: coverage and concentration of household visits, medical consultation, and nursing consultation. RESULTS: 386 of the 687 individuals with hypertension or diabetes had records of their condition at the Primary Healthcare Units; medical consultation coverage (69.2%) was regular, while nursing consultation (1.5%) and household visit (12.2%) indices were critical; concentration was critical for household visits, nursing consultations, and medical consultations for high-risk groups; medical consultation coverage was higher among women, those with lower schooling, and those attending Primary Healthcare Units (p < 0.05), but did not differ with regard to cardiovascular risk. CONCLUSION: follow-up by the teams does not meet the healthcare standard set for the programmatic groups analyzed.

OBJETIVO: evaluar el acompañamiento de adultos con hipertensión arterial y/o diabetes por los equipos de Salud de la Familia e identificar factores asociados, en la ciudad Cambé-PR, Brasil, el 2012. MÉTODOS: investigación evaluativa de análisis documental, se calcularon los indicadores de cobertura y concentración de visita domiciliaria, consulta médica y de enfermería. RESULTADOS: de los 687 individuos con hipertensión y/o diabetes, 386 tenían registro de esta condición en las unidades básicas; la cobertura de consulta médica (69,2%) fue regular, las de consulta de enfermería (1,5%) y visita domiciliaria (12,2%) fueron críticas; la concentración se reveló crítica en visitas domiciliarias, consultas de enfermería y médicas en los grupos de alto riesgo; las coberturas de consulta médica fueron más altas en mujeres, individuos de menor escolaridad y que utilizaban unidades básicas de salud (p < 0,05) sin diferencias con respecto al riesgo cardiovascular. CONCLUSIÓN: el acompañamiento por los equipos no atiende el padrón asistencial establecidopara los grupos programáticos analizados.

Síndrome metabólica, componentes e fatores associados em adultos de 40 anos ou mais de um município da Região Sul do Brasil / Metabolic syndrome, components and associated factors in adults aged 40 years or older from a city in southern Brazil

Resumo Objetivo Estimar a prevalência de síndrome metabólica (SM), de seus componentes e fatores associados em adultos de 40 anos ou mais. Métodos Estudo transversal, de base populacional, com 1.180 residentes em um município brasileiro de médio porte da Região Sul. Realizaram-se entrevistas domiciliares, avaliações antropométricas e exames laboratoriais. A SM foi definida de acordo com o critério harmonizado de 2009. Foram analisadas variáveis sociodemográficas, comportamentais e de utilização de serviços de saúde. Utilizaram-se o teste de qui-quadrado, exato de Fisher e teste de Wald na análise de múltiplos fatores pela regressão de Poisson. Resultados Entre os entrevistados, 959 (81,3%) realizaram exames laboratoriais e medidas antropométricas. A prevalência de SM foi de 53,7%, mais elevada em mulheres e em idades mais avançadas. A presença de cinco componentes da SM foi observada em 12% dos participantes (15,8% mulheres e 7,3% homens). Após ajustes, apenas a idade se associou à SM. Conclusão A elevada prevalência de SM e de seus componentes, distinta em cada sexo e grupo etário, aponta a necessidade de ações de enfrentamento com abordagens coletivas e estabelecimento de metas terapêuticas individuais.

Abstract Aims To estimate the prevalence of Metabolic Syndrome (MS), its components and associated factors in adults aged 40 years or older. Methods Cross-sectional population-based study, with 1180 residents in a Southern Brazilian medium-sized municipality. We conducted household interviews, anthropometric measurements and laboratory tests. MS was defined according to the harmonized criteria of 2009. Sociodemographic, behavioral variables, and health services utilization were analyzed. The tests used were Chi-square, Fisher's exact test and the Wald test in the analysis of multiple factors by Poisson regression. Results Among the respondents, 959 (81.3%) performed laboratory tests and anthropometric measures. The prevalence of MS was 53.7% higher in women and in older ages. The presence of five MS components was observed in 12.0% (women – 15.8%, men – 7.3%). Age was the only variable associated with MS after adjustments. Conclusion The high prevalence of MS and its components, different in each sex and age group, indicates the need for coping with collective action approaches and establishment of individual therapeutic goals.

Avaliação da cobertura da Atenção Básica na detecção de adultos com diabetes e hipertensão / Evaluation of the coverage of Primary Health Care in detecting adults with diabetes and hypertension

O presente estudo documental avaliou a detecção das pessoas com hipertensão e/ou diabetes pelas Unidades Básicas de Saúde (UBS), identificadas em estudo de base populacional. Entre os 606 indivíduos incluídos, 386 (63,7%) apresentaram registro de hipertensão e/ou diabetes na Ficha A, no Sishiperdia ou nos prontuários. A frequência de detecção foi significativamente mais elevada entre as pessoas de pior estrato econômico, que não exerciam atividade ocupacional e utilizavam a UBS. Os resultados mostram cobertura regular, predominantemente dos que utilizam os serviços e apontam necessidade de estratégias que ampliem o reconhecimento da população-alvo da atividade programática.

This documentary study evaluated the detection of people with hypertension and/or diabetes by Basic Health Units (UBS), identified in a populational based study. Among the included 606 individuals, 386 (63.7%) of them had a record of hypertension and/or diabetes on Record A, in Sishiperdia or in the charts of UBS. The detection frequency was significantly higher among people with a worse economic stratum, who did not have an occupation and used the UBS. The results show regular coverage, predominantly those who use the services and point to the need of strategies to enhance the recognition of the target population of the program activity.

Análise da demanda atendida em unidade de urgência com classificação de risco / Analysis of the demand in urgency with risk classification

O objetivo desta pesquisa foi analisar a classificação de risco em serviço de urgência de um hospital. Foram amostrados 976 usuários que procuraram atendimento, cujos dados foram coletados nas fichas preconizadas pelo protocolo de atendimento médico. Predominaram pessoas do sexo masculino, na faixa etária de 20 a 59 anos, que procuraram o serviço em dias úteis e horário comercial. Foram considerados adequados à demanda para o atendimento no serviço de urgência 82,3% dos pacientes, com associação significativa entre adequação e as variáveis procedência e horário de atendimento. A implantação do protocolo contribuiu para a identificação dos casos mais graves e organização da demanda.

The objective of this research was to analyze the risk rating at the emergency department of a hospital. We sampled 976 users who sought treatment, whose data were collected from records at forms recommended by protocol and medical care. Results showed that 20-59 year-old males, attending the service on weekdays and during business hours, were predominant 82,3% of patients were considered adequate to meet the demand in the emergency department. There was a significant association between adequacy and the variables origin and opening hours. The implementation of the protocol helped identifying the most serious cases and demand organization.

Diferenças entre sexos nos determinantes da obesidade abdominal em adultos de 40 anos ou mais: estudo de base populacional / Gender differences in the determinants of abdominal obesity among adults aged 40 years or older: A population-based study

Objetivo:Verificar diferenças entre sexos na prevalência de excesso de peso abdominal e seus determinantes em adultos a partir de 40 anos de idade.Métodos:Estudo transversal de base populacional realizado no município de Cambé, Paraná, com 1.161 indivíduos de 40 anos de idade ou mais, residentes em todos os setores censitários urbanos. A obesidade abdominal foi definida como circunferência da cintura ≥88 cm para mulheres e ≥102 cm para homens. A análise de fatores associados foi realizada para cada sexo por meio da regressão de Poisson hierarquizada baseada em modelo teórico conceitual, com seleção de variáveis distais, intermediárias e proximais.Resultados:A prevalência de obesidade abdominal foi de 49,7% e aumentou com a idade para ambos os sexos. A prevalência em mulheres foi mais que o dobro da verificada em homens (RP=2,29; IC95%=1,98-2,65). Após ajuste, as variáveis que permaneceram associadas à obesidade abdominal em ambos os sexos foram: inatividade física no lazer, idade e hipertensão arterial. Classe econômica, tabagismo e diabetes associaram-se com a obesidade abdominal apenas entre as mulheres.Conclusão:As altas prevalências de obesidade abdominal, especialmente no sexo feminino, e a presença de alguns fatores associados distintamente em cada sexo evidenciam a necessidade de ações diferenciadas de enfrentamento.

Objective:To investigate gender differences in the prevalence of excess abdominal weight and its determinants in adults aged 40 years and over.Methods:Cross-sectional population-based study conducted in the city of Cambé, Paraná, Brazil, with 1,161 individuals 40 years or older living in all urban sectors. Abdominal obesity was defined as a waist circumference ≥88 cm in women and ≥102 cm in men. The analysis of associated factors was performed for each gender using the hierarchical Poisson regression based on a conceptual theoretical model, with the selection of distal, intermediate, and proximal variables.Results:The prevalence of abdominal obesity was 49.7%, which increased with age in both genders. Women had more than double the prevalence compared to men (PR=2.29; 95%CI=1.98-2.65). After adjustment, the following variables remained associated with abdominal obesity in both genders: physical inactivity, age, and hypertension. Socioeconomic status, smoking, and diabetes were associated with abdominal obesity only in women.Conclusion:The high prevalence of abdominal obesity, especially among women, and the presence of some factors found to be distinctly associated in each gender show the need for different measures to address this issue.

Relationship between social capital indicators and lifestyle in Brazilian adults / Asociación entre indicadores de capital social y estilo de vida en adultos brasileños / Associação entre indicadores de capital social e estilo de vida em adultos brasileiros

The present study examined the relationship between indicators of social capital and health-related behaviors. A cross-sectional study was conducted on a sample of 1,062 participants representative of the population aged 40 years or older from a city in Southern Brazil. The following indicators of social capital were examined: number of friends, number of people they could borrow money from when in need; extent of trust in community members; number of times members of the community help each other; community safety; and extent of membership in community activities. Also, an overall score of social capital including all indicators was calculated. A poor social capital was associated with insufficient leisure-time physical activity (OR = 1.70; 95%CI: 1.07-2.70), low consumption of fruits and vegetables (OR = 1.53; 95%CI: 1.05-2.24), and smoking (OR = 1.97; 95%CI: 1.21-3.21). No clear association was found between capital social and binge drinking. A score of social capital showed an inverse relationship with the number of prevalent risk behaviors (p < 0.001). These results reinforce that policies to promote health should consider social capital.

El objetivo del estudio fue investigar la relación entre indicadores de capital social y los comportamientos relacionados con la salud. Se realizó un estudio transversal con 1.062 personas representativas de la población de 40 años o más, de una ciudad del Sur del Brasil. Los indicadores de capital social fueron: número de amigos y personas que prestan dinero si fuera necesario, la confianza en la gente del barrio, la frecuencia con la que la gente del barrio se ayuda mutuamente, la seguridad del barrio y la participación comunitaria. También se construyó una puntuación del capital social en base a indicadores aislados de capital social. Un bajo capital social se asoció con la inactividad física en el tiempo libre (OR = 1,70; IC95%: 1,07-2,70), el consumo irregular de frutas y verduras (OR = 1,53; IC95%: 1,5-2,24), y el tabaquismo (OR = 1,97; IC95%: 1,21-3,21). No hubo una clara relación entre el capital social y el abuso de alcohol. La puntuación del capital social ha tenido una relación inversa con el número de conductas de riesgo (p < 0,001). Estos resultados refuerzan la importancia de considerar el capital social en las políticas de promoción de la salud.

O objetivo do estudo foi verificar a associação entre indicadores de capital social e comportamentos relacionados à saúde. Foi realizado um estudo transversal com uma amostra de 1.062 sujeitos representativos da população de 40 anos ou mais de um município da Região Sul do Brasil. Os indicadores de capital social foram: número de amigos, pessoas que emprestariam dinheiro em caso de necessidade, confiança nas pessoas do bairro, frequência com que as pessoas no bairro se ajudavam, segurança no bairro e participação comunitária. Foi ainda calculado um escore de capital social que considerou os indicadores isolados. Baixo capital social foi associado com inatividade física no lazer (OR = 1,70; IC95%: 1,07-2,70), consumo irregular de frutas e verduras (OR = 1,53; IC95%: 1,05-2,24) e tabagismo (OR = 1,97; IC95%: 1,21-3,21). Não foi encontrada associação clara do capital social com o consumo abusivo de álcool. O escore de capital social mostrou uma relação inversa com o número de comportamentos de risco (p < 0,001). Esses resultados reforçam a importância de se considerar o capital social nas políticas de promoção da saúde.

Association between social capital and self-perception of health in Brazilian adults / Associação entre capital social e autopercepção de saúde em adultos brasileiros

OBJECTIVE To investigate the association between social capital and social capital and self-perception of health based on examining the influence of health-related behaviors as possible mediators of this relationship.METHODS A cross-sectional study was used with 1,081 subjects, which is representative of the population of individuals aged 40 years or more in a medium-sized city in Southern Brazil. The subjects who perceived their health as fine, bad or very bad were considered to have a negative self-perception of their health. The social capital indicators were: number of friends, people from whom they could borrow money from when needed; the extent of trust in community members; whether or not members of the community helped each other; community safety; and extent of participation in community activities. The behaviors were: physical activity during leisure time, fruits and vegetable consumption, tobacco use and alcohol abuse. The odds ratios (OR) and confidence intervals (CI) 95% were calculated by binary logistic regression. The significance of mediation was verified using the Sobel test.RESULTS Following adjustment for demographic and clinical variables, subjects with fewer friends (OR = 1.39, 95%CI 1.08;1.80), those who perceived less frequently help from people in the neighborhood (OR = 1.30, 95%CI 1.01;1.68), who saw the violent neighborhood (OR = 1.33, 95%CI 1.01;1.74) and who had not participated in any community activity (OR = 1.39, 95%CI 1.07;1.80) had more negative self-perception of their health. Physical activity during leisure time was a significant mediator in the relationship between all social capital indicators (except for the borrowed money variable) and self-perceived health. Fruit and vegetable consumption was a significant mediator of the relationship between the extent of participation in community activities and self-perceived health. Tobacco use and alcohol abuse did not seem to have a mediating role in any relationship.CONCLUSIONS Lifestyle seems to only partially explain the relationship between social capital and self-perceived health. Among the investigated behaviors, physical activity during leisure time is what seems to have the most important role as a mediator of this relationship.

OBJETIVO Analisar a associação entre indicadores de capital social e autopercepção de saúde com base em comportamentos relacionados à saúde como possíveis mediadores dessa relação.MÉTODOS Realizou-se estudo transversal com 1.081 sujeitos, representativos da população de 40 anos ou mais de município da região Sul do Brasil. Os sujeitos que percebiam sua saúde como regular, ruim ou muito ruim foram considerados com autopercepção negativa. Os indicadores de capital social foram: número de amigos; pessoas que emprestariam dinheiro em caso de necessidade; confiança nas pessoas do bairro; frequência de ajuda entre as pessoas do bairro; segurança no bairro; e participação comunitária. Os comportamentos investigados foram prática de atividade física no lazer, consumo de frutas e verduras, tabagismo e consumo abusivo de álcool. A razão de odds (OR) e seus intervalos de confiança (IC) 95% foram calculados por regressão logística binária, em diferentes modelos. A significância da mediação foi verificada pelo teste de Sobel.RESULTADOS Na análise ajustada pelas variáveis demográficas e clínicas, maior autopercepção negativa de saúde foi apresentada por pessoas com menor número de amigos (OR = 1,39; IC95% 1,08;1,80), que percebiam menor frequência de ajuda entre as pessoas no bairro (OR = 1,30; IC95% 1,01;1,68), que consideravam o bairro violento (OR = 1,33; IC95% 1,01;1,74) e que não haviam participado de atividade comunitária (OR = 1,39; IC95% 1,07;1,80). A atividade física no lazer foi um mediador significativo na relação entre todos os indicadores de capital social, e a autopercepção de saúde. O consumo de frutas e verduras foi um mediador significativo da relação entre a participação comunitária e a autopercepção de saúde. Tabagismo e consumo abusivo de álcool não mediaram nenhuma relação.CONCLUSÕES O estilo de vida parece explicar parcialmente a relação entre capital social e autopercepção de saúde. Dos comportamentos investigados, a atividade física no lazer parece ter papel mais importante como mediador dessa relação.

Nao adesao ao tratamento medicamentoso continuo: prevalencia e determinantes em adultos de 40 anos e mais / Non-adherence to continuous treatment and associated factors: prevalence and determinants in adults 40 years and older / Falta de adherencia al tratamiento farmacologico continuo: prevalencia y factores determinantes en adultos mayores de 40 anos

O presente estudo investiga os fatores associados a não adesão à terapia medicamentosa contínua em indivíduos de 40 anos e mais de idade. Foi realizado um inquérito de base populacional em Cambé, Paraná, Brasil. A adesão à terapia foi avaliada pela escala de quatro itens de Morisky et al. e analisaram-se também variáveis sociodemográficas, de utilização dos serviços de saúde e do uso de medicamentos. Foram entrevistados 1.180 indivíduos, dos quais 78% utilizaram medicamentos nos 15 dias anteriores à entrevista e em 55% registrou-se o uso contínuo. A amostra do estudo consistiu em 639 indivíduos, com predominância do sexo feminino, idade entre 40 e 59 anos, baixa escolaridade. A prevalência de não adesão foi de 63,5%. Após análise ajustada, permaneceram associados a não adesão: não ser acompanhado pelo agente comunitário de saúde, ter tido descontinuidade no acesso aos medicamentos e a elevada frequência de utilização dos medicamentos ao longo do dia. Os resultados indicam uma alta prevalência da não adesão com possíveis impactos negativos para os indivíduos e para a sociedade.

This study investigates factors associated with non-adherence to continuous drug therapy in individuals 40 years and older. A population-based survey was conducted in Cambé, Paraná State, Brazil. Treatment adherence was assessed with the four-item Morisky et al. medication adherence scale. The study also assessed socio-demographic variables and health services access and use of medication. Among 1,180 interviewees, 78% reported use of medication, with continuous use in 55%. The study analyzed 639 individuals, the majority female, ranging from 40 to 59 years of age, with low schooling, and from socioeconomic stratum C (on a scale from A to E). Prevalence of non-adherence was 63.5%. Mean therapeutic complexity was 8.1. After adjusted analysis, the following factors remained associated with non-adherence: not being assisted by community health workers, discontinuous access to medication, and high frequency of medication throughout the day. The results indicate high prevalence of non-adherence, with potentially negative impacts for individuals and society.

Este artículo investiga los factores asociados a la falta de adherencia en el tratamiento continuo con personas con 40 años o más de edad. Llevamos a cabo un estudio basado en la población de Cambé, Paraná, Brasil. La adhesión al tratamiento se evaluó mediante la escala de 4 ítems Morisky et al. También se han analizado variables sociodemográficas, uso de servicios de salud y medicamentos. Fueron entrevistadas 1.180 personas, de las cuales el 78% había consumido medicamentos durante los 15 días anteriores a la entrevista y en un 55% se registró un uso continuo. La muestra del estudio consistió en 639 individuos, principalmente mujeres, con edades comprendidas entre los 40 y 59 años y con baja educación. La prevalencia de no-adhesión fue de un 63,5%. Después del ajuste de análisis, la falta en el acceso a los medicamentos y la alta frecuencia de uso de medicamentos durante el día se asoció con el hecho de no estar acompañado por un trabajador comunitario de salud. Los resultados indican una alta prevalencia de falta de adherencia con los consiguientes posibles impactos negativos para los individuos.

Diseases of the circulatory system before and after the family health program, Londrina, Paraná.

BACKGROUND: The reduction in morbidity and mortality rates from diseases of the circulatory system (DCS) is one of the greatest challenges in primary care, and the implementation of the Family Health Program provides access to the multisectoral and integrated measures required for dealing with these diseases. OBJECTIVE: To analyze DCS mortality and hospitalization rates before and after the implementation of the Family Health Program, in Londrina, Paraná. METHODS: This was an ecological study, comparing DCS, cerebrovascular disease (CbVD) and ischemic heart disease (IHD) mortality rates and hospitalization rates by the SUS, in residents of Londrina, in two 4-year periods: 1997 to 2000, and 2002 to 2005. The data were obtained from the Mortality Information System and the Hospital Information System of the SUS. The ratios between the rates were calculated for both periods at 95% confidence interval. RESULTS: The DCS was the first cause of death in the city, in both quadrennia. The CbVD and IHD accounted for more than 63% of DCS deaths. In comparing the two quadrennia, there was a reduction in CbVD mortality rates, which was significant only for subjects over 59 years, in both genders, and the hospitalization rates increased by 10%. For IHD, no significant change occurred in mortality rates, and there was a 40% increase in hospitalization rates. CONCLUSION: The significant reduction only in CbVD mortality in the elderly suggests the need for expanding health assistance coverage to different population groups and the development of preventive and health promotion measures.

Síndrome metabólica em estudos com adultos brasileiros: uma revisão sistemática / Metabolic syndrome in studies with Brazilian adults: a systematic review

A Síndrome Metabólica é definida pela presença simultânea de componentes da resistência à insulina, da hipertensão e da dislipidemia, condição essa relacionada às doenças cardiovasculares. Trata-se uma revisão sistemática das bases PubMed, Scielo, Lilacs e outras fontes, de 2000 a junho de 2013 de estudos transversais com amostras representativas que apresentassem a SM segundo uma dasdefinições a seguir: International Diabetes Federation (IDF), Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol inou Harmonizada. A prevalência de SM variou de 7,1% (adultos jovens) a 56,9% (idosos) observando-se aumento da SM com a idade. Entre os sexos não houve uma distinção clara das prevalênciasencontradas. Os valores obtidos com a definição IDF foram maiores em relação às demais definições. Entre os componentes da SM houve o predomínio de baixo HDL, alteração dos níveis pressóricos eobesidade abdominal. Houve grande variação da prevalência de SM, impossibilitando uma inferência da prevalência da SM entre brasileiros. Todavia, reforçou sua relação com o aumento da idade e demonstrou maior prevalência dos componentes baixo HDL-C e alteração da pressão...

Metabolic syndrome is defined by the simultaneous presence of components that define insulin resistance, hypertension, and dyslipidemia, a condition closely related to cardiovascular diseases. It is a systematic review of Pubmed, Scielo, Lilacs and other sources, from January 2000 to June 2013 ofcross-sectional studies with representative samples that presented the MetS according to one of the following definitions: International Diabetes Federation (IDF), Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol or Harmonized criteria. The prevalence of MetS ranged from 7.1% (young adults) to 56.9% (elderly) with anincrease in MetS with aging. There was no clear distinction of prevalence between genders. The values obtained with the IDF definition were higher in relation to others definitions. Low HDL and changes in blood pressure predominated among MetS components. The prevalence of MetS found in Brazilian studies showed a large variation, making it impossible to infer a prevalence of MetS among Brazilians.However, the relationship with aging was reinforced, and the study highlighted the higher prevalence of low HDL-C and changes in blood pressure...

Quality of external-cause data in the Hospitalization Information System.

OBJECTIVE: To analyze the coverage and quality of the data on hospitalizations due to external causes in the Hospital Information System of the Brazilian National Health System. METHODS: Hospitalizations recorded in the Hospital Information System of 11 hospitals in two municipalities (Londrina and Maringá, Southern Brazil), in 2004, were compared with hospitalizations identified as consequences of external causes through investigating medical records, complemented with mortality and pre-hospital data. The crude agreement rate, sensitivity and positive predictive value were calculated. The profile of groups of hospitalization causes recorded in the System was compared with that obtained from investigations. RESULTS: In Londrina, 3,002 hospitalizations due to external causes were recorded in the System and, in Maringá, 1,403. The investigations found 4,018 and 2,370, respectively. The System presented high positive predictive values for hospitalizations due to external causes in both municipalities: 97.7% in Londrina and 98.6% in Maringá. However, the sensitivity was low: 57.3% in Maringá and 73% in Londrina, thus denoting underrecording of these causes. Comparison between the profiles of the types of causes revealed that there was underestimation of some causes in the System, especially regarding accidents due to exposure to inanimate mechanical forces, assaults and intentional self-harm. CONCLUSIONS: Underrecording of hospitalizations due to external causes and some distortions regarding the types of causes occurred in the Hospital Information System in both municipalities. Detection of these deficiencies may contribute towards the process of improving the quality of the information in this System.