Trend of the hospitalizations due to ambulatory care sensitive conditions in pediatrics in distrito federal / Tendencia de las internaciones por patologías pasibles de atención primaria em pediatría en el distrito federal / Tendência das internações por condições sensíveis à atenção primária em pediatria no distrito federal

ABSTRACT Objective: to analyze the trend of hospitalizations due to Ambulatory Care Sensitive Conditions in Pediatrics in Distrito Federal, during the 2008-2018 period. Method: a time series study conducted between 2008 and 2018 with data from Distrito Federal, Brazil, in the age group from 0 to 14 years old. The data were collected in the SUS Hospital Information System, and they were used to perform trend analyses of the most frequent groups. Results: there was a trend towards a significant increase in hospitalizations in the age group studied, with an annual percentage variation of 1.42% and a confidence interval between 0.05 and 2.81. Four groups of reasons for hospitalization and diagnoses were more frequent in the period, namely: bacterial pneumonias, infectious gastroenteritis and complications, pulmonary diseases, and asthma. Among the most frequent groups, considering the study period, there was a trend towards a significant increase in pulmonary diseases (15.71%; 12.40 and 19.12); a trend towards a significant reduction in infectious gastroenteritis and complications (-5.35%; -8.01 and 2.61); and a stationary trend in bacterial pneumonias (-0.43%; -3.80 and 3.07) and asthma (3.82%; 0.57 and 8.40). Conclusion: the results of this study can contribute to the planning, evaluation and monitoring of primary care actions, as this indicator aims at indirectly evaluating access and effectiveness of this care level. In this sense, considering the results of the trend analysis performed, it can be concluded that they do not yet reflect the expected results with the expansion of FHS coverage.

RESUMEN Objetivo: analizar la tendencia de las internaciones por patologías pasibles de atención primaria en Pediatría en el Distrito Federal, en el período de 2008 a 2018. Método: estudio de series temporales con datos del Distrito Federal, Brasil, en el grupo etario de 0 a 14 años, realizado entre 2008 y 2018. Los dados se recolectaron desde el Sistema de Información Hospitalaria del SUS, con los cuales se realizaron análisis de tendencia de los grupos más frecuentes. Resultados: se registró una significativa tendencia de aumento en las internaciones, dentro del grupo etario del estudio, cuya variación porcentual anual fue del 1,42% con un intervalo de confianza entre 0,05 y 2,81. Cuatro grupos de causas de internación y diagnósticos fueron más frecuentes en el período, a saber: neumonías bacterianas, gastroenteritis infecciosas y complicaciones, enfermedades pulmonares y asma. Entre los grupos más frecuentes, considerando el período del estudio, hubo una significativa tendencia de aumento en las enfermedades pulmonares (15,71%; 12,40 y 19,12); así como una significativa tendencia decreciente en las gastroenteritis infecciosas y complicaciones (-5,35%; -8,01 y 2,61) y una tendencia estacionaria en las neumonías bacterianas (-0,43%; -3,80 y 3,07) y en el asma (3,82%; 0,57 y 8,40). Conclusión: los resultados de este estudio pueden contribuir en la planificación, la evaluación y el control de las acciones en atención primaria, ya que la intención de este es evaluar indirectamente el acceso y la efectividad de este nivel de atención. En este sentido, y considerando los resultados del análisis de tendencia realizado, se puede concluir que dichos resultados todavía no reflejan los esperados con la ampliación de la cobertura de la ESF.

RESUMO Objetivo: analisar a tendência de internações por condições sensíveis à atenção primária em pediatria no Distrito Federal, no período de 2008 a 2018. Método: estudo de séries temporais com dados do Distrito Federal, Brasil, na faixa etária de 0-14 anos, entre 2008 e 2018. Os dados foram coletados no Sistema de Informações Hospitalares do SUS, com os quais foram realizadas análises de tendência dos grupos mais frequentes. Resultados: houve tendência de aumento significante nas internações, na faixa etária do estudo, cuja variação percentual anual foi de 1,42% e intervalo de confiança entre 0,05 e 2,81. Quatro grupos de causas de internação e diagnósticos foram mais frequentes no período: pneumonias bacterianas, gastroenterites infecciosas e complicações, doenças pulmonares e asma. Entre os grupos mais frequentes, considerando o período do estudo, houve tendência de aumento significante nas doenças pulmonares (15,71%; 12,40 e 19,12); tendência de redução significante nas gastroenterites infecciosas e complicações (-5,35%; -8,01 e 2,61); e tendência estacionária nas pneumonias bacterianas (-0,43%; -3,80 e 3,07) e asma (3,82%; 0,57 e 8,40). Conclusão: os resultados deste estudo podem contribuir no planejamento, avaliação e monitoramento das ações da atenção primária, visto que este indicador se propõe a avaliar indiretamente acesso e efetividade desse nível de atenção. Nesse sentido, considerando os resultados da análise de tendência realizada, pode-se concluir que os mesmos não refletem, ainda, os resultados esperados com a ampliação da cobertura de ESF.

El rol histórico de la cesárea y su relación con la mortalidad materna / The historical role of cesarean section and its relationship with maternal mortality

Resumen Antecedentes: Existe consenso en que la cesárea ha sido fundamental en la disminución de la morbimortalidad materno-infantil, sin embargo, desde 1985 expertos consultados por la Organización Mundial de la Salud (OMS), concluyeron que la tasa ideal de cesáreas debe oscilar entre el 10 y el 15%. La proporción real actual supera ampliamente lo recomendado. El último informe de la Organización para la Cooperación y el Desarrollo Económicos (OCDE), publicado en enero de 2019, señala a Chile en el tercer lugar con mayor porcentaje de cesáreas. Este dato es preocupante, ya que el exceso de intervenciones quirúrgicas vs. parto normal se asocia a un aumento de la morbimortalidad materna y a un mayor riesgo para el recién nacido. Objetivo: Revisar los porcentajes de cesáreas en las muertes maternas, tanto en establecimientos públicos como privados de la región de Los Lagos, Chile, y detectar si existe una asociación entre cesáreas y mortalidad materna. Resultados: Se puede apreciar una relación entre las cesáreas y las muertes maternas.

Abstract Background: There is consensus that cesarean section has been essential in reducing maternal and child morbidity and mortality, however, since 1985 experts consulted by the World Health Organization (WHO), concluded that the ideal rate of cesarean sections should range between 10 and 15%. The current and real proportion exceeds what is recommended. The latest report from the Organization for Economic Cooperation and Development (OECD), published in January 2019, places Chile in third place with the highest percentage of cesarean sections. This data is worrying since the excess of surgical interventions vs. normal delivery is associated with increased maternal morbidity and mortality and increased risk to the newborn. Objective: To review the percentages of cesarean sections in maternal deaths, both in public and private establishments in the Los Lagos region, Chile, and to detect if there is an association between cesarean sections and maternal mortality. Results: A relationship between cesarean sections and maternal deaths, can be seen.

Aspectos metodológicos para priorização de municípios: a experiência da diretoria da atenção básica / Methodological aspects for prioritizing municipalities: the experience of the primary care board / Aspectos metodológicos para la priorización de municipios: la experiencia de la junta de atención primaria

A Estratégia Saúde da Família é o eixo orientador do modelo assistencial brasileiro. Uma das responsabilidades dos Estados, estabelecida na Política Nacional de Atenção Básica (PNAB), é prestar apoio institucional aos municípios no processo de implantação, acompanhamento e qualificação da Atenção Básica e de ampliação e consolidação da Estratégia Saúde da Família. Na Bahia, a Diretoria da Atenção Básica (DAB) da Secretaria da Saúde do Estado é responsável por prestar apoio institucional aos municípios, por meio dos Colegiados dos Coordenadores de Atenção Básica e de visitas técnicas às cidades. Entretanto, o estado da Bahia enfrenta escassez de recursos humanos e financeiros, em especial para acompanhar os municípios in loco cumprindo suas responsabilidades. Dessa maneira, identificou-se a necessidade de priorizar os municípios, a partir de indicadores de saúde, para o acompanhamento presencial pelos apoiadores institucionais dos níveis central e regional. Assim, este trabalho tem como objetivo descrever o processo de elaboração de ferramenta informatizada para priorização de municípios para a intervenção presencial do apoio institucional da DAB e dos Núcleos Regionais de Saúde (NRS). Para compor a ferramenta, foram selecionados 13 indicadores, organizados em planilha no Microsoft Excel (2007), distribuindo os 417 municípios nas linhas e os indicadores e seus valores nas colunas. Os valores alcançados pelos municípios em cada um dos indicadores foram estratificados e ponderados de acordo com parâmetros definidos pela literatura e/ou área técnica responsável. Ao final, foi atribuída uma nota por município, sendo cinquenta a pontuação máxima possível. Assim, a partir do Instrumento de Priorização de Municípios, as cidades que apresentaram as maiores pontuações foram definidas como prioritárias para atuação dos apoiadores institucionais.

The Family Health Strategy is the guiding axis of the Brazilian care model. According to the National Primary Care Policy (PNAB), one of the responsibilities of the States is to provide institutional support to municipalities in implementing, monitoring, and qualifying primary care, as well as in expanding and consolidating the Family Health Strategy. In Bahia, the Primary Care Board (DAB) of the State Health Department is responsible for providing institutional support to municipalities through the Boards of Primary Care Coordinators and for conducting technical visits to municipalities. However, the state of Bahia faces a shortage of human and financial resources, specially to monitor the municipalities in loco, thus indicating the need for prioritizing the municipalities that will be monitored by institutional supporters based on health indicators at the central and regional levels. Thus, this paper aims to describe the development of a computerized tool for prioritizing municipalities to receive on-site intervention from the DAB and the Regional Health Departments (RHDs). Such a tool consisted of 13 indicators organized in a Microsoft Excel spreadsheet (2007) by distributing the 417 municipalities in the lines and the indicators and their values in the columns. The values achieved by the municipalities in each of the indicators were stratified and weighted according to parameters defined by the literature and/or responsible technical area. Then, each municipality was assigned a score, being 50 the maximum possible. The Instrument for Prioritization of Municipalities allowed for determining priority municipalities (those with the highest scores) to receive monitoring by institutional supporters.

La Estrategia de Salud Familiar es el eje orientador del modelo de atención brasileño. Una de las responsabilidades de los estados que establece la Política Nacional de Atención Primaria (PNAB) es brindar apoyo institucional a los municipios en el proceso de implementación, seguimiento y calificación de la Atención Primaria, así como en la expansión y consolidación de la Estrategia de Salud Familiar. En Bahía (Brasil), la Junta de Atención Primaria (DAB) de la Secretaría de Salud del Estado se encarga de brindar apoyo institucional a los municipios, a través del Colegio de Coordinadores de Atención Primaria y de visitas técnicas a los municipios. Sin embargo, el estado de Bahía se enfrenta a una escasez de recursos humanos y financieros, en particular en el seguimiento de los municipios in loco respecto al cumplimiento de sus responsabilidades. De esta manera, se pretende investigar la necesidad de priorizar, con base en indicadores de salud, los municipios para el seguimiento presencial por parte de los apoyos institucionales en el ámbito central y regional. Así, este trabajo tiene como objetivo describir el proceso de elaboración de una herramienta computarizada de priorización de municipios para la intervención in situ con apoyo institucional de la DAB y de los Núcleos Regionales de Salud (NRS). Para componer la herramienta se seleccionaron 13 indicadores, organizados en una hoja de cálculo de Microsoft Excel (2007), distribuyendo los 417 municipios en líneas y los indicadores y sus valores en columnas. Los valores alcanzados por los municipios en cada uno de los indicadores fueron estratificados y ponderados según parámetros definidos por la literatura y/o el área técnica responsable. Al final, se asignó una puntuación por municipio, siendo 50 la máxima puntuación posible. Así, a partir del Instrumento de Priorización de Municipios, se definieron los municipios prioritarios con mayores puntajes para el desempeño de los apoyadores institucionales.

Enhancing Sustainability in Healthcare Delivery—A Challenge to the New Malaysia

@#There have been substantial improvements in the health indicators since Malaysia achieved independence. These were accomplished through strong primary healthcare services addressing maternal and paediatric health, as well as the successful control of communicable diseases. The rate of decline in the mortality statistics has been at a virtual standstill, or at best, almost plateaued since 2000. However, with the plethora of national health issues at both the policy and delivery levels, we cannot continue on with ‘business as usual’. Therefore, we must strategise effective and practical approaches to a renewed and revamped national healthcare services for a modern ‘New Malaysia’ that are compatible with our quest toward the status of a ‘truly developed’ nation.

Indicador de salubridade ambiental: variações da formulação e usos do indicador no Brasil / Indicator of environmental health: formula modifications and indicator applications in Brazil

RESUMO O Indicador de Salubridade Ambiental (ISA) foi criado, em 1999, pelo Conselho Estadual de Saneamento (Conesan) do Estado de São Paulo. Embora tenha sido formado com o objetivo de medir o nível de salubridade ambiental dos municípios paulistas, o ISA tem sido utilizado em diversas Regiões do Brasil. Além disso, ao longo desses 17 anos, o ISA vem sendo alterado em sua formulação original, de acordo com as características do local a ser avaliado, como é sugerido pelo manual que o originou. Diante disso, o objetivo deste artigo foi avaliar o estado da arte da utilização do ISA no Brasil, identificando avanços, lacunas e desafios de seu uso. Para isso, realizou-se amplo levantamento bibliográfico a fim de encontrar estudos disponíveis em meios eletrônicos que utilizaram o ISA. Foram identificados e analisados 60 casos. As Regiões Nordeste e Sul do país são as que possuem a maior quantidade de estudos e a maioria deles (41,6%) é resultado de dissertações de mestrado. Cada estudo utiliza, em média, seis indicadores de primeira ordem e a revisão bibliográfica é método preponderante para escolhê-los e ponderá-los. Por fim, foi mostrado que as diferenças entre os ISA na verdade são um empecilho para a utilização desse indicador. Uma vez que cada estudo possui suas peculiaridades em termos de indicadores, pesos e critérios de cálculo, só é possível fazer comparações dos resultados obtidos entre um mesmo estudo ao longo do tempo, mas essas diferenças impossibilitam a comparação entre os valores obtidos em diferentes estudos.

ABSTRACT The Environmental Health Indicator (Indicador de Salubridade Ambiental - ISA) was established in 1999 by the São Paulo's State Council of Sanitation (Conesan). Although this indicator was created to measure the level of environmental health of the municipalities in São Paulo state, Brazil, ISA has been applied in several other regions of Brazil. Moreover, throughout these 17 years, the original ISA formulation has been altered according with local characteristics, as suggested by the manual that originated it. Thus, this study aimed to evaluate ISA application state of the art in Brazil, by the identification of the progress, gaps, and challenges of its use. An extensive literature investigation was performed in order to find studies available in electronic media that used ISA. We identified and analyzed 60 cases. The Northeast and South regions are those with the greatest number of studies, and the majority of them (41.6%) are result of master's dissertations. Each study uses an average of six first order indicators, and the literature review is the predominant method for choosing and evaluating them. Finally, we showed that the differences between the ISAs are actually a drawback for this indicator use. Since each study has peculiarities in terms of indicators, weights, and criteria calculation, it is only possible to compare the results from the same study over time, but these differences preclude the comparison between the values obtained in different studies.

The Effects of a Secondary Stroke Prevention Program on the Health Risk Indicators and Self-Care Compliance of Stroke Patients

PURPOSE: This study aimed to investigate the effects of a secondary stroke prevention education program on the health risk indicators and self-care compliance of stroke patients. METHODS: A non-equivalent control group pretest-posttest design was used to select the participants. Subjects were 54 stroke patients (27 in the experimental group and 27 in the control group) hospitalized in a K university hospital in D city, Korea. Health risk indicators and self-care compliance were measured both for a baseline, as well as after intervention. The data was analyzed using a chi-square test, paired t-test and ANCOVA. RESULTS: There were significant differences in systolic blood pressure, diastolic blood pressure, fasting blood sugar, weight and self-care compliance. CONCLUSION: The results of the study indicate that an educational secondary stroke prevention program is effective for health risk indicators and self-care compliance of patients. Therefore it can be used as an effective nursing intervention in clinical practice.

Spatial distribution of trachoma cases in the City of Bauru, State of São Paulo, Brazil, detected in 2006: defining key areas for improvement of health resources

Introduction The objective of this study was to analyze the spatial behavior of the occurrence of trachoma cases detected in the City of Bauru, State of São Paulo, Brazil, in 2006 in order to use the information collected to set priority areas for optimization of health resources. Methods the trachoma cases identified in 2006 were georeferenced. The data evaluated were: schools where the trachoma cases studied, data from the 2000 Census, census tract, type of housing, water supply conditions, distribution of income and levels of education of household heads. In the Google Earth® software and TerraView® were made descriptive spatial analysis and estimates of the Kernel. Each area was studied by interpolation of the density surfaces exposing events to facilitate to recognize the clusters. Results Of the 66 cases detected, only one (1.5%) was not a resident of the city's outskirts. A positive association was detected of trachoma cases and the percentage of heads of household with income below three minimum wages and schooling under eight years of education. Conclusions The recognition of the spatial distribution of trachoma cases coincided with the areas of greatest social inequality in Bauru City. The micro-areas identified are those that should be prioritized in the rationalization of health resources. There is the possibility of using the trachoma cases detected as an indicator of performance of micro priority health programs. .

Comparison of anthropometric data and clinical health indicators according to the serum vitamin B12 status in female older adults living in a rural area of Jeonla province, Korea / 한국영양학회지

Subclinical vitamin B12 deficiency is common in the elderly worldwide. We investigated the change of serum vitamin B12 concentration with aging and compared anthropometric data and clinical health indicators between normal (> or = 340 pg/mL) and low (< 340 pg/mL) serum vitamin B12 groups in 470 Korean women aged 65 years and over living in a rural area. Serum vitamin B12 concentration showed inverse correlation with age (r = -0.0992, p < 0.05). The normal B12 group showed significantly (p < 0.05) higher red blood cell count, hemoglobin, and hematocrit compared to the low B12 group, however, no difference in mean corpuscular volume was observed between the two groups. The normal B12 group showed significantly lower serum homocysteine concentration (p < 0.01) and prevalence of vitamin D (p < 0.01) or folate deficiency (p < 0.001). Bone mineral density (T-score) was significantly higher (p < 0.05) in the normal B12 group, compared with that in the low B12 group, and showed positive correlation (r = 0.1490, p < 0.01) with serum vitamin B12 concentration after adjusting for age, body weight, and body mass index. No differences in anthropometric data, physical activity, and smoking and drinking habits were observed between the two groups. In conclusion, it could be suggested that older female adults with normal serum vitamin B12 level would be less anemic and osteoporotic and more resistant to hyperhomocysteinemia associated chronic diseases than those with low serum vitamin B12 level.

Consideraciones actuales sobre la operación cesárea / Current considerations on cesarean section

El incremento de la cesárea, que constituye la operación obstétrica más comúnmente efectuada, ha sido motivo de preocupación en los últimos años. En esta revisión se ha perseguido identificar básicamente los problemas que genera este aumento, a fin de que pueda servir no solo como estrategia para el análisis y control de la ejecución de ese proceso en los servicios de obstetricia, sino como herramienta de trabajo para los gerentes de salud; pero en el artículo se ha tratado también lo concerniente al impacto de este tipo de cirugía en la morbilidad y mortalidad maternas, por lo cual se concluye que este es un proceder quirúrgico que debe reservarse para cuando exista una fundamentación científica confirmada para su realización, con vistas a garantizar el resultado exitoso en el binomio madre-hijo.

The increase of cesarean section, that constitutes the most commonly obstetric operation carried out, has been reason of concern in the last years. The aim in this review has been to identify basically the problems generated by this increase, so that it can serve not only as strategy for the analysis and control of that process in the surgical services, but also as work tool for the health managers; the work has also dealt with impact of this surgery type in the maternal morbidity and mortality, reason why it is concluded that this is a surgical procedure that should be reserved in case of a confirmed scientific reason for its realization, for guaranteeing the successful result in the binomial mother-son.

Development of Mental Health Indicators in Korea

OBJECTIVE: Promoting mental health and preventing mental health problems are important tasks for international organizations and nations. Such goals entail the establishment of active information networks and effective systems and indicators to assess the mental health of populations. This being said, there is a need in Korea develop ways to measure the state of mental health in Korea. METHODS: This paper reviews the mental health indicator development policies and practices of seven organizations, countries, and regions: WHO, OECD, EU, United States, Australia, UK, and Scotland. Using Delphi method, we conducted two surveys of mental health indicators for experts in the field of mental health. The survey questionnaire included 5 domains: mental health status, mental health factor, mental health system, mental health service, and quality of mental health services. We considered 124 potential mental health indicators out of more than 600 from indicators of international organizations and foreign countries. RESULTS: We obtained the top 30 mental health indicators from the surveys. Among them, 10 indicators belong to the mental health system. The most important five mental health indicators are suicide rate, rate of increase in mental disorder treatment, burden caused by mental disorders, adequacy of identifying problems of mental health projects and deriving solutions, and annual prevalence of mental disorders. CONCLUSION: Our study provides information about the process for indicator development and the use of survey results to measure the mental health status of the Korean population. The aim of mental health indicator development is to improve the mental health system by better grasping the current situation. We suggest these mental health indicators can monitor progress in efforts to implement reform policies, provide community services, and involve users, families and other stakeholders in mental health promotion, prevention, care and rehabilitation.

Cartas de control estadístico de procesos en el monitoreo de la mortalidad perinatal / Statistical process control charts in perinatal mortality surveillance

Objetivo Aplicar la metodología de las cartas de control estadístico de procesos (SPC) en la vigilancia de la mortalidad perinatal, indicador de la salud materno-perinatal. Método Las cartas de control fueron elaboradas utilizando 286 muertes perinatales y los 51 840 nacimientos, ocurridos en la Empresa Promotora de Salud SUSALUD, entre enero de 2004 y diciembre de 2007. Se elaboraron dos cartas de control, la primera se hizo teniendo en cuenta como línea central la proporción de muertes perinatales en cada uno de los meses y como límites superior e inferior de control la proporción de muertes ±3 SD, la segunda se elaboró calculando los logits de las proporciones de las muertes perinatales. Resultados Se construyeron dos cartas control para la vigilancia de la mortalidad perinatal. La primera tuvo en cuenta las proporciones de muertes perinatales para cada uno de los meses dando un promedio para el proceso de cinco muertes perinatales por cada mil nacimientos (p=0,005), para la segunda carta control se calcularon los logits de las proporciones de muertes perinatales. Conclusiones Disponer de las cartas SPC para el monitoreo y posterior análisis de la mortalidad perinatal, permitirá detectar rápidamente los cambios en la calidad del servicio, evaluar aspectos de la calidad de la atención materno-infantil y programar intervenciones específicas.

Objective Applying statistical process control (SPC) charts in perinatal mortality surveillance (as an epidemiological indicator). Method The control charts were prepared using 51,840 births; 286 cases were produced from these births. All information came from SUSALUD between January 2004 and December 2007. Two control charts are presented; the first one's central line was considered to be the proportion of cases + 3 SD and the second one used the logits from the percentages of cases. Results Two control charts were prepared for monitoring perinatal mortality. The first considered the percentage of cases per month and an average of five cases per one thousand births was obtained (p=0.005). The logits were used for the second chart. Conclusions Having SPC charts available for monitoring and analysing perinatal mortality will allow changes in service quality to be quickly detected and let aspects regarding the quality of the service being provided for mothers and the newborn to be evaluated. Specific interventions can also be programmed.

Diferenciais sociodemográficos no declínio funcional em mobilidade física entre os idosos no Brasil / Socio-demographic differentials in the functional decline among the elderly in Brazil

Verifica-se uma positiva reversão de expectativa das condições gerais de saúde da população idosa, possivelmente devido ao progresso da tecnologia médica, mudanças comportamentais, desenvolvimento de programas específicos para idosos, elevação do status socioeconômico e modificações no padrão epidemiológico da população. Este estudo tem por objetivo analisar diferenciais sociodemográficos nas taxas de prevalência de incapacidade em mobilidade física entre os idosos no Brasil. Os dados utilizados foram os da PNAD, de 1998 e 2003, realizada pelo IBGE, envolvendo duas amostras, representativas nacionalmente, de 28.943 e de 35.042 pessoas de 60 anos ou mais. A escolha do indicador de incapacidade funcional recaiu sobre a variável "dificuldade para caminhar cerca de 100 metros". As medidas de status sociodemográfico incluíram sexo, grupos de idade, região de residência e renda familiar mensal per capita. Houve redução, estatisticamente significativa, das taxas de prevalência de incapacidade funcional, em mobilidade física, entre as pessoas idosas, no período considerado. As políticas públicas direcionadas para os idosos devem focalizar a ampliação da diminuição da carga da capacidade funcional.

There is a positive reversion in the expectations regarding the health condition of the elderly population, possibly due to the progresses in medical technology; behavioural changes; development of special programmes for the elderly; improvements in the socio-economic status; decrease of infectious diseases. This study aims analyzing differentials in the prevalence rates of mobility disability among elderly people in Brazil. The data used were from 'The 1998 and 2003 National Household Survey (PNAD)', conducted by the Brazilian Institute of Geographic and Statistics (IBGE). The two samples were nationally representative, including approximately 30 thousand individuals aged 60 years or more respectively. "Difficulty to walk more than 100 meters" was the variable selected as the indicator of disability. Socio-demographic status measures were sex, age group, region of residence and family income per capita. Comparison of the PNAD results of 1998 and 2003 showed that over that period in Brazil the elderly disability rates decreased among all socio-demographic groups considered. Public policies directed to the elderly must focus on reducing mobility disability.

Analysis of Community Health Status and Related Factors Using Community Health and Social Indicators

PURPOSE: The purpose of this paper was to investigate community health status and related factors using community health and social indicators. METHOD: Data sources were reviewed and data for 10 categories, 75 indicators were collected. Community health status and health-related factors were categorized, and the means and standard deviation of individual indicators were obtained and standardized scores were calculated. In addition, through factor analysis of individual indicators by category using the scores and using the resultant factor coefficients as weights, indexes were calculated by area. Correlation and regression were analyzed. RESULT: Each indicator was highly correlated with each index, and the indexes were highly correlated with one another. Correlation coefficients were above 0.8 between community health index and population, education, housing, and economy, between population and education, housing and economy, between education and housing and economy, and between housing and economy, environment and industry. But multicollinearity was not found in the result. Significant factors on community health index were population, health personnel and facilities, education, housing and economy, and R-square were 92.4%. CONCLUSION: Health determinants such as population, health personnel and facilities, education, housing and economy could be influencing factors on community health in community level. These results showed the importance of intersectoral collaboration within a local government. Overall community health can be enhanced by intersectoral collaboration.