The vulnerable male, or the sex ratio among fetal deaths in Brazil

Some studies indicate the existence of innate male vulnerabilities, especially during the perinatal period. The current study is a cross-sectional analysis of fetal mortality in Brazil according to sex from 2000 to 2009, stratified by maternal characteristics (age, schooling, and gestational age), using Ministry of Health data (DATASUS). The analysis included all fetal deaths from 2000 to 2009, except when the sex of the fetus was not recorded. The male/female sex ratio (SR) for all fetal deaths was 1.188. Analysis of maternal characteristics showed that the SR was statistically higher (p < 0.01) in mothers that were younger (10-14 years), had no formal schooling, and with gestational age < 22 weeks. The study showed a statistically higher-than-expected SR (p < 0.01) for 13 underlying causes of death and a lower SR for two others. The results suggest a potential innate male vulnerability.

Family Health Support Centers: challenges and opportunities from the perspective of primary care professionals in the city of Sao Paulo, Brazil

Family Health Support Centers (NASF) were created in Brazil to increase the case-resolution capacity of primary healthcare. Prior to their implementation in the West Side of the city of Sao Paulo, Brazil, a series of workshops were held for primary healthcare professionals to prepare a proposal for such centers. Hermeneutic analysis was used to study the transcribed material. The thematic categories were: role, constitution, and functioning of the NASF, relationship with family health teams, and interdisciplinarity. The participants' expected the NASF to be an empowering device for comprehensiveness of care, intervening in an existing culture of unnecessary referrals while fostering linkage with other levels of care. The participants also expected the NASF to contribute to the discussion on health professionals' training and stimulating reflection with policy-makers on health indicators based exclusively on the number of consultations. These indicators fail to reflect the impact on the services' activities and the quality of care offered to the population in the coverage area.

Relevant methodological issues from the SBBrasil 2010 Project for national health surveys

The SBBrasil 2010 Project (SBB10) was designed as a nationwide oral health epidemiological survey within a health surveillance strategy. This article discusses methodological aspects of the SBB10 Project that can potentially help expand and develop knowledge in the health field. This was a nationwide survey with stratified multi-stage cluster sampling. The sample domains were 27 State capitals and 150 rural municipalities (counties) from the country's five major geographic regions. The sampling units were census tracts and households for the State capitals and municipalities, census tracts, and households for the rural areas. Thirty census tracts were selected in the State capitals and 30 municipalities in the countryside. The precision considered the demographic domains grouped by density of the overall population and the internal variability of oral health indices. The study evaluated dental caries, periodontal disease, malocclusion, fluorosis, tooth loss, and dental trauma in five age groups (5, 12, 15-19, 35-44, and 65-74 years).

Evolution in access to fluoridated water in Sao Paulo State, Brazil, from the 1950s to the early 21st century

Access to fluoridated water is a known protective factor against dental caries. In 1974, fluoridation of the public water supply became mandatory by law in Brazil, resulting in improved coverage, especially in more developed regions of the country. Coverage increased across the country as a priority under the national oral health policy. This article systematizes information on the implementation and expansion of fluoridation in Sao Paulo State from 1956 to 2009, using secondary data from technical reports, official documents, and the Information System for Surveillance of Water Quality for Human Consumption (SISAGUA). In 2009, fluoridation covered 546 of 645 counties in Sao Paulo State (84.7%), reaching 85.1% of the total population and 93.5% of the population with access to the public water supply. The results indicate that fluoridation has been consolidated as part of State health policy. However, the challenge remains to implement and maintain fluoridation in 99 counties, benefiting 6.2 million inhabitants that are still excluded from this service.

Uso de substâncias na adolescência e problemas familiares

Esta pesquisa visou a avaliar a associação entre o consumo de substâncias (álcool, tabaco e drogas ilícitas) e problemas familiares numa amostra de 965 adolescentes em 50 escolas públicas de dois municípios do Estado de São Paulo, Brasil, em 2007. Foi utilizado o Drug Use Screening Inventory (DUSI) para a coleta de dados. O uso de álcool, tabaco e drogas ilícitas foi associado à avaliação negativa da relação familiar, à falta de suporte/monitoramento e ao uso de substâncias por familiares (p < 0,05). Os estudantes que relataram ter feito uso de substâncias apresentaram mais problemas familiares do que aqueles que não consumiram nenhuma substância (p < 0,001). Os adolescentes que usaram álcool e tabaco (p = 0,028) e drogas ilícitas (p < 0,001) relataram ter mais problemas familiares do que aqueles que usaram apenas álcool. Os resultados apontam para a importância de se ficar atento ao consumo de álcool e tabaco entre os adolescentes, já que o relato do consumo das duas substâncias esteve associado a prejuízos familiares significativos, semelhantes ao uso de drogas ilícitas.

Hospital costs related to streptococcal meningitis among children in Sao Jose dos Campos, Sao Paulo State, Brazil

Knowledge of hospital costs is highly important for public health decision-making. This study aimed to estimate direct hospital costs related to pneumococcal meningitis in children 13 years or younger in the city of Sao Jose dos Campos, Sao Paulo State, Brazil, from January 1999 to December 2008. Data were obtained from medical records. Hospital costs were calculated according to the mixed method for measurement of quantities of items with identified costs and value attribution to items consumed (micro-costing and gross-costing). All costs were calculated according to monetary values for November 2009 and in Brazilian currency (Real). Epi Info 3.5.1 was used for frequencies and means analysis. Forty-one cases were reported. Direct hospital costs varied from R$ 1,277.90 to R$ 19,887.56 (mean = R$ 5,666.43), or 10 to 20 times the mean cost of hospitalization for other diseases. Hospital staff labor was the highest cost, followed by medication, procedures, supplies, and lab tests.

Cost and energy density of diet in Brazil, 2008-2009

This study aimed to evaluate the relationship between the cost and energy density of diet consumed in Brazilian households. Data from the Brazilian Household Budget Survey (POF 200812009) were used to identify the main foods and their prices. Similar items were grouped, resulting in a basket of 67 products. Linear programming was applied for the composition of isoenergetic baskets, minimizing the deviation from the average household diet. Restrictions were imposed on the inclusion of items and the energy contribution of the various food groups. A reduction in average cost of diet was applied at intervals of R$0.15 to the lowest possible cost. We identified an inverse association between energy density and cost of diet (p < 0.05), and at the lowest possible cost we obtained the maximum value of energy density Restrictions on the diet's cost resulted in the selection of diets with higher energy density, indicating that cost of diet may lead to the adoption of inadequate diets in Brazil.

Voice disorders related to job stress in teaching: a case-control study

This case-control study aimed to test the association between voice disorders and job stress among public schoolteachers in Sao Paulo, Brazil. The groups consisted of teachers with (n = 165) and without (n = 105) voice-related complaints. Both groups answered the questionnaires Conditions of Vocal Production and Job Stress Scale. Analysis of cases and controls showed comparable samples, differing only by vocal symptoms. There was a statistically significant difference between cases and controls in relation to job stress involving high strain (OR = 2.1;95%CI: 1.1-3.9), which places high demands combined with low job control. High strain in cases in this study represents the highest risk of physical and mental disorders for teachers. Loss of voice prevents teachers from continuing in their professional role, eliminates their professional identity, and jeopardizes their career.

Self-reported hearing loss among elderly individuals in the city of Sao Paulo, Brazil: prevalence and associated factors (SABE Study, 2006)

This article describes the prevalence of self-reported hearing loss in an elderly population in the city of Sao Paulo, Brazil, and associated factors, based on a cross-sectional descriptive and quantitative study. The sample consisted of individuals over 65 years of age selected from census tracts in two stages, with replacement and probability proportional to the population 75 years of age or older. Statistical analysis used Stata 10 with weighted data, Rao-Scott test, and backward stepwise Poisson regression. 1,115 elders were interviewed. Prevalence of self-reported hearing loss was 30.4%, and higher levels were associated with age over 75 years, male gender, self-reported musculoskeletal conditions, dizziness, visual impairment, and difficulty using the telephone. Increased knowledge of factors associated with hearing loss would support public policies on hearing. The high prevalence found in this study underlines the importance of addressing this issue among the elderly.

Cost-effectiveness of conventional and modified supervised toothbrushing in preventing caries in permanent molars among 5-year-old children

The cost-effectiveness of a modified supervised toothbrushing program was compared to a conventional program. A total of 284 five-year-old children presenting at least one permanent molar with emerged/sound occlusal surface participated. In the control group, oral health education and dental plaque dying followed by toothbrushing with fluoride dentifrice was carried outfour times per year. With the test group, children also underwent professional cross-brushing on surfaces of first permanent molar rendered by a dental assistant five times per year. Enamel/dentin caries were recorded on buccal, occlusal and lingual surfaces of permanent molars for a period of 18 months. The incidence density (ID) ratio was estimated using Poisson's regression model. The ID was 50% lower among boys in the test group (p = 0.016). The cost of the modified program was US$ 1.79 per capita. The marginal cost-effectiveness ratio among boys was US$ 6.30 per avoided carie. The modified supervised toothbrushing program was shown to be cost-effective in the case of boys.

Educational levels and the functional dependence of ischemic stroke survivors

We evaluated the functional dependence of stroke survivors from the Study of Stroke Mortality and Morbidity, using the Rankin Scale. Out of 355 ischemic stroke survivors (with a mean age of 67.9 years), 40% had some functional dependence at 28 days and 34.4% had some functional dependence at 6 months. Most predictors of physical dependence were identified at 28 days. These predictors were: low levels of education [illiterate vs. >= 8 years of education, multivariate odds ratio (OR) = 3.7; 95% confidence interval (95%CI): 1.60-8.54] and anatomical stroke location (total anterior circulation infarct, OR = 16.9; 95%CI: 2.93-97.49). Low levels of education and ischemic brain injury influenced functional dependence in these stroke survivors. Our findings reinforce the necessity of developing strategies for the rehabilitation of stroke patients, more especially in formulating specific strategies for care and treatment of stroke survivors with low socioeconomic status.

Current issues regarding health surveillance of fluoride concentrations in foods

This study analyzed the position of the Federal (Brazil), State (Sao Paulo), and municipal (Bauru, Sao Paulo) governments, civil society representatives, the regulated sector, and research associations concerning issues with fluoride content in foods. Analysis of the interviews (N = 15) used a qualitative methodology (collective subject discourse theory). Various central ideas were identified, including the need for stronger health surveillance in monitoring and controlling fluoride levels, educational measures, and more research in the area. The study concludes that the health surveillance approach to fluoride levels in foods is necessary, but still incipient. There is a mismatch between research output and surveillance. Regulation alone does not suffice to solve all the issues. Health risk communication and health education measures need to be implemented. Issues with fluoride on food labels need further research for the intervention to be effective.

Articulação entre serviços públicos de saúde nos cuidados voltados à saúde mental infantojuvenil

O objetivo do estudo é descrever e analisar as articulações que se realizam entre as equipes da Estratégia Saúde da Família (ESF) e Centro de Atenção Psicossocial Infantojuvenil (CAPSI), tendo em vista as ações voltadas à saúde mental de crianças e adolescentes. Foram realizadas entrevistas semidirigidas com gerentes de cinco CAPSI e 13 Unidades Básicas de Saúde com ESF, de 5 regiões distintas no Município de São Paulo, Brasil, que foram transcritas e analisadas mediante perspectiva hermenêutica. A articulação entre as equipes da ESF e CAPSI se dá prioritariamente por encaminhamento de casos, apoio matricial ou parceria para casos considerados pertinentes ao CAPSI. Falta de recursos humanos, cobrança por produtividade e ausência de capacitação dos profissionais da ESF para trabalhar com saúde mental foram mencionadas como obstáculos para a efetiva articulação entre os serviços. A lógica do encaminhamento e da desresponsabilização, bem como a hegemonia do modelo biomédico e a consequente fragmentação dos cuidados se mostram vigentes no cotidiano dos serviços.

Association between particulate matter air pollution and monthly inhalation and nebulization procedures in Ribeirao Preto, Sao Paulo State, Brazil

The study was designed to investigate the impact of air pollution on monthly inhalation/nebulization procedures in Ribeirao Preto, Sao Paulo State, Brazil, from 2004 to 2010. To assess the relationship between the procedures and particulate matter (PM10) a Bayesian Poisson regression model was used, including a random factor that captured extra-Poisson variability between counts. Particulate matter was associated with the monthly number of inhalation/nebulization procedures, but the inclusion of covariates (temperature, precipitation, and season of the year) suggests a possible confounding effect. Although other studies have linked particulate matter to an increasing number of visits due to respiratory morbidity, the results of this study suggest that such associations should be interpreted with caution.

Relação entre violência física, consumo de álcool e outras drogas e bullying entre adolescentes escolares brasileiros

O objetivo deste estudo foi identificar a associação entre o consumo de álcool e outras drogas e o bullying com o envolvimento em situações de violência física entre adolescentes de 13 a 15 anos, em escolas públicas e privadas das capitais brasileiras e do Distrito Federal. Foram analisados os dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) de 2009. Para análise dos dados foi utilizada a regressão logística. A prevalência de envolvimento em situações de violência física foi 12,9% maior no sexo masculino. Em ambos os sexos, foram observadas associações entre violência física e ser vítima de bullying com o uso de drogas ilícitas e efeito potencializado do consumo de álcool e drogas. Para o sexo masculino, o uso de álcool mostrou associação significante com violência física. Morar o pai ou ambos os genitores na residência apresentou associação inversa para violência física no sexo feminino. O conhecimento de fatores associados à violência física entre adolescentes é importante para auxiliar estratégias de promoção da saúde e da cultura de paz, rompendo com a ideia de que a violência entre adolescentes é algo banal e esperado.