Some predictors of cardiovascular mortality among the elderly population of Botucatu (SP)

OBJECTIVE: To detect factors associated with cardiovascular mortality in the elderly of Botucatu. METHODS: We evaluated 29 variables of interest in a cohort of patients aged ³60 using data from a survey conducted between 1983/84. The elderly cohort was analyzed in 1992 to detect the occurrence of cardiovascular deaths. Survival analysis was performed using the Kaplan-Meier method, the log-rank test, and Cox regression analysis. Three models were adapted for each group of variables, and a final model was chosen from those variables selected from each group. RESULTS: We identified predictor for cardiovascular death according to age for elderly males not supporting the family, not possessing a vehicle, and previous cardiovascular disease. In elderly females, the predictor variables were previous cardiovascular disease and diabetes mellitus. CONCLUSION: Socioeconomic indicators (family heading and vehicle ownerrship) may be added to well stabilished medical factors (diabete mellitus and hypertension to select target groups for programs intended to reduce deaths due to cardiovascular diseases in elderly people.

Prevalence of trachoma in a population of the upper Rio Negro basin and risk factors for active disease

Purpose: To determine the prevalence of trachoma in Sao Gabriel da Cachoeira (SGC), the only urban community of the upper Rio Negro Basin of the Amazon state in Brazil, near the Colombian border, and to investigate the risk factors associated with the active forms of the disease. Methods: A total of 1702 people (440 children up to 9 years and 1069 adults aged 15 years and above) were examined. The sample was selected from a probabilistic household sampling procedure based on census data and a previous study of trachoma prevalence in Sao Gabriel da Cachoeira. A two-stage probabilistic household cluster sample was drawn. Household units were randomly selected within each cluster. A variety of socioeconomic and hygiene variables were studied in order to determine the risk factors for active trachoma in a household. Results: The total prevalence of trachoma was 8.9%. Prevalence of active trachoma (TF and/or TI) in children aged 1-9 years was 11.1% and trachomatous trichiasis in adults aged 15 years and above was 0.19%. Trachomatous scarring reached a peak of 22.4% for subjects between 50 to 60 years of age. Corneal opacity occurred in subjects aged 50 years and older with a prevalence of 2.0%. No sex effect was found on the overall prevalence of trachoma in SGC. Risk factors associated with active trachoma were mainly related to poor socioeconomic indicators. Conclusions: Despite the ubiquitous presence of water, the analysis of the risk factors associated with the active forms of the disease supports the idea that a low personal standard of hygiene and not water availability per se, is the key factor associated with trachoma. Copyright © 2008 Informa Healthcare USA, Inc.

Social policies in transitional societies: is the Latin American experience useful?

Includes bibliography

Indicadores do potencial de gestão municipal de recursos hídricos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Geotecnologias aplicadas em estudo socioeconômico da ocupação urbana: o bairro Cidade Nova do município de Timon (MA)

Pós-graduação em Geografia - IGCE

Análise da sustentabilidade na produção familiar no Sudeste Paraense: o caso dos produtores de leite do Município de Rio Maria

Neste trabalho é feita uma análise da sustentabilidade da pecuária leiteira na agricultura familiar, decorrente do rápido processo de degradação das pastagens formadas em área de terra firme, numa região de fronteira da Amazônia brasileira. A pesquisa foi realizada no Município de Rio Maria, Sudeste Paraense, sendo este um dos Municípios do Pará reconhecido internacionalmente pelo alto índice de conflitos fundiários. Foram entrevistadas 55 unidades de produção familiar, nos Projetos de Assentamentos Itaipavas 126, Barra Mansa, Mata Azul, Fazenda São Roque e Vale da Serra que sobrevivem, especificamente, da pecuária leiteira, que foram entrevistados nos meses de julho a agosto de 2002. A escolha das propriedades foi intencional, e constitui-se na identificação da renda da pecuária (venda do leite e reses), bem como, uma análise das técnicas utilizadas pelos pequenos produtores, no manejo das pastagens, do rebanho para garantir a sustentabilidade da unidade produtiva. Essa análise permitiu identificar através dos indicadores socioeconômicos que, embora a pecuária seja considerada uma atividade de baixo risco, economicamente viável para a Amazônia, entre os pequenos produtores, torna-se uma atividade insustentável, posto que, o processo de degradação das pastagens inicia-se a partir de três a cinco anos, sem, no entanto, permitir que as unidades de produção poupem recursos para renovação ou recuperação. A renda sustentável da atividade de pecuária leiteira sendo muito baixa em relação à renda obtida logo na fase inicial da atividade desestimula a adoção de práticas mais sustentáveis. A tendência declinante da produtividade das pastagens, com leves acréscimos decorrentes das queimadas e de controle da juquira tem sido compensadas com a incorporação de novas áreas de pastagens. O esgotamento de estoques de reservas florestais tende levar ao colapso da atividade, a despeito da existência de mercado para carne e leite, as práticas de recuperação não são adotadas. Considerando uma taxa de depreciação de pastagens de 10% ao ano e uma taxa de juros de 15% ao ano, do lucro líquido obtido os proprietários deveriam investir pelo menos 40% para garantir a sustentabilidade das pastagens ao final de dez anos. Verifica-se que a pecuária leiteira da agricultura familiar está sendo feita com a contínua drenagem dos recursos naturais, sem a devida compensação no preço de venda desses produtos (leite e carne). Espera-se que estes resultados possam contribuir para definir políticas públicas, com medidas concretas para os pequenos produtores de leite, no sentido de garantir renovação/recuperação das pastagens degradadas, visto que, são estes produtores os responsáveis por grande parte do desequilíbrio ecológico do ecossistema no Sudeste Paraense. Entre os pequenos criadores de gado não há necessidade de financiamento para contínua aquisição do gado, pois todos os proprietários já possuem rebanho acima da capacidade das pastagens. Nesse caso, seria necessária capacitação do produtor capacitação do produtor, para manejo adequado do pasto e do rebanho e financiamentos voltados para recuperação das pastagens degradadas. Não existe entre os produtores um espírito de conservação, mas sim uma ansiedade em aumentar o rebanho e as pastagens.

Concentração, integração horizontal e vertical das usinas canavieiras

Pós-graduação em Agronomia - FEIS

Distribuição geográfica de agravos nutricionais entre escolares na cidade de Piracicaba-SP, Brasil

The objective was to map the prevalence of nutritional disorders in children attending the 1st to 4th grade of 12 public elementary schools located in the 5 administrative regions of Piracicaba, SP, each with its own socioeconomic profi le, from 2003 to 2006. A total of 16,068 children, divided into 8,133 (50.6%) girls and 7,935 (49.4%) boys, aged 7 to 11 years, were weighed and measured. Their nutritional status indicators heightfor-age (H/A), weight-for-age (W/A), and body mass index-for-age (BMI/A) were compared with those of the NCHS/CDC 2000 reference population and classifi ed according to the z-score cut-off points recommended by the World Health Organization. During that period, the Western Region, which has the lowest socioeconomic indicators, had the lowest z-score medians of the three anthropometric indicators assessed (p<0.0001) and was the only region to have a higher-than-expected stunting prevalence (3.0% with Z < -2). Excess weight prevalence was higher than expected in all regions. The Central Region, which has the highest socioeconomic indicators, had the highest excess weight prevalence (6.0% with Z > 2). Time had a positive effect on the stunted children, reducing the stunting rates in the regions with the lowest socioeconomic indicators. In conclusion, the three nutritional status indicators showed results suitable to the social and economic characteristics of each region. Although nutritional disorders have particular characteristics, they are a problem to the entire population.

Sala de recursos multifuncionais: um estudo de caso

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Caracterização clínica epidemiológica e geográfica da hanseníase em município hiperendêmico do Brasil

Pós-graduação em Saúde Coletiva - FMB

Caracterização clínica epidemiológica e geográfica da hanseníase em município hiperendêmico do Brasil

Pós-graduação em Saúde Coletiva - FMB

Suicide rates and income in Sao Paulo and Brazil: a temporal and spatial epidemiologic analysis from 1996 to 2008

Background: In a classical study, Durkheim noted a direct relation between suicide rates and wealth in the XIX century France. Since that time, several studies have verified this relationship. It is known that suicide rates are associated with income, although the direction of this association varies worldwide. Brazil presents a heterogeneous distribution of income and suicide across its territory; however, evaluation for an association between these variables has shown mixed results. We aimed to evaluate the relationship between suicide rates and income in Brazil, State of Sao Paulo (SP), and City of SP, considering geographical area and temporal trends. Methods: Data were extracted from the National and State official statistics departments. Three socioeconomic areas were considered according to income, from the wealthiest (area 1) to the poorest (area 3). We also considered three regions: country-wide (27 Brazilian States and 558 Brazilian micro-regions), state-wide (645 counties of SP State), and city-wide (96 districts of SP city). Relative risks (RR) were calculated among areas 1, 2, and 3 for all regions, in a cross-sectional approach. Then, we used Joinpoint analysis to explore the temporal trends of suicide rates and SaTScan to investigate geographical clusters of high/low suicide rates across the territory. Results: Suicide rates in Brazil, the State of SP, and the city of SP were 6.2, 6.6, and 5.4 per 100,000, respectively. Taking suicide rates of the poorest area (3) as reference, the RR for the wealthiest area was 1.64, 0.88, and 1.65 for Brazil, State of SP, and city of SP, respectively (p for trend <0.05 for all analyses). Spatial cluster of high suicide rates were identified at Brazilian southern (RR = 2.37), state of SP western (RR = 1.32), and city of SP central (RR = 1.65) regions. A direct association between income and suicide were found for Brazil (OR = 2.59) and the city of SP (OR = 1.07), and an inverse association for the state of SP (OR = 0.49). Conclusions: Temporospatial analyses revealed higher suicide rates in wealthier areas in Brazil and the city of SP and in poorer areas in the State of SP. We further discuss the role of socioeconomic characteristics for explaining these discrepancies and the importance of our findings in public health policies. Similar studies in other Brazilian States and developing countries are warranted.

Age of First Dental Visit and Predictors for Oral Healthcare Utilisation in Preschool Children

Purpose: To assess the age the of the first dental visit and the association of self-perceived oral health, socioeconomic and clinical indicators with healthcare utilisation in Brazilian preschool children. Materials and Methods: An epidemiological survey with 455 5- to 59-month-old children was conducted on National Children's Vaccination Day in Santa Maria, RS, Brazil. Data about age and reasons for the first dental visit, healthcare utilisation, socioeconomic status and self-perceived oral health were collected by means of a parental semi-structured questionnaire. Calibrated examiners evaluated the prevalence of dental caries (WHO) and dental trauma. The assessment of the association used Poisson regression models (prevalence ratio; 95% confidence interval [Cl]). Results: A total of 24.2% (95% Cl: 20.3% to 28.4%) of the study sample had already had a first dental visit. Older children, those with dental caries and dental trauma and whose mothers had a higher level of education were more likely to have gone to the dentist. Children of low socioeconomic status were more likely to have visited public than private healthcare services. The reasons for the first dental visit were associated with clinical indicators of the sample. The distribution of utilisation of the types of oral healthcare services (public or private) varied across the socioeconomic groups. Non-white children with dental caries and dental trauma tended to visit a dentist only for treatment reasons. Conclusion: Socioeconomic and clinical indicators are associated with the use of dental services, indicating the need for strategies to promote public health and reorientation of services that facilitate dental access for preschool children.

Iniquidades socioeconômicas na conformação dos padrões alimentares de crianças e adolescentes

OBJETIVO: Identificar e quantificar a influência dos fatores socioeconômicos sobre os padrões alimentares. MÉTODOS: Estudo transversal de base populacional com amostra de 1.136 crianças e adolescentes de 7 a 14 anos de idade, de ambos os sexos, matriculados na rede pública de Salvador (BA), Brasil. O consumo alimentar foi medido por meio do questionário qualitativo de frequência alimentar. Os padrões de consumo foram identificados por meio de análise de componentes principais. Para o estudo da influência dos indicadores socioeconômicos na conformação dos padrões alimentares, foram utilizados modelos de regressão quantílica. RESULTADOS: Os padrões alimentares extraídos foram classificados em padrão obesogênico e padrão tradicional. Nos modelos de regressão quantílica, ajustados por faixa etária e por sexo, o menor grau de instrução materna esteve associado negativamente, em níveis significantes, na maioria dos percentis, ao consumo de alimentos que integram o padrão obesogênico. A baixa renda associou-se negativamente aos maiores percentis (p>95). Os dados indicam não haver influência dos indicadores socioeconômicos sobre o consumo de alimentos que integram o padrão tradicional. CONCLUSÃO: Conclui-se que há influência dos fatores socioeconômicos na adesão ao padrão obesogênico de consumo. Esse conjunto de resultados requer a atenção dos gestores públicos para a identificação de um padrão de consumo ocidental, visualizado amplamente nos estudos em que se avaliam padrões de consumo adotados na atualidade pela população brasileira - sobretudo por crianças e adolescentes -, caracterizados por englobar componentes alimentares de risco para as doenças crônicas não transmissíveis.

Spatial clusters of suicide in the municipality of Sao Paulo 1996-2005: an ecological study

Background: In a classical study, Durkheim mapped suicide rates, wealth, and low family density and realized that they clustered in northern France. Assessing others variables, such as religious society, he constructed a framework for the analysis of the suicide, which still allows international comparisons using the same basic methodology. The present study aims to identify possible significantly clusters of suicide in the city of Sao Paulo, and then, verify their statistical associations with socio-economic and cultural characteristics. Methods: A spatial scan statistical test was performed to analyze the geographical pattern of suicide deaths of residents in the city of Sao Paulo by Administrative District, from 1996 to 2005. Relative risks and high and/or low clusters were calculated accounting for gender and age as co-variates, were analyzed using spatial scan statistics to identify geographical patterns. Logistic regression was used to estimate associations with socioeconomic variables, considering, the spatial cluster of high suicide rates as the response variable. Drawing from Durkheim's original work, current World Health Organization (WHO) reports and recent reviews, the following independent variables were considered: marital status, income, education, religion, and migration. Results: The mean suicide rate was 4.1/100,000 inhabitant-years. Against this baseline, two clusters were identified: the first, of increased risk (RR = 1.66), comprising 18 districts in the central region; the second, of decreased risk (RR = 0.78), including 14 districts in the southern region. The downtown area toward the southwestern region of the city displayed the highest risk for suicide, and though the overall risk may be considered low, the rate climbs up to an intermediate level in this region. One logistic regression analysis contrasted the risk cluster (18 districts) against the other remaining 78 districts, testing the effects of socioeconomic-cultural variables. The following categories of proportion of persons within the clusters were identified as risk factors: singles (OR = 2.36), migrants (OR = 1.50), Catholics (OR = 1.37) and higher income (OR = 1.06). In a second logistic model, likewise conceived, the following categories of proportion of persons were identified as protective factors: married (OR = 0.49) and Evangelical (OR = 0.60). Conclusions: This risk/ protection profile is in accordance with the interpretation that, as a social phenomenon, suicide is related to social isolation. Thus, the classical framework put forward by Durkheim seems to still hold, even though its categorical expression requires re-interpretation.