The impact of changing health indicators on infant mortality rates in Brazil, 2000 and 2005 / Impacto de los cambios en los indicadores de salud sobre las tasas de mortalidad infantil en Brasil, 2000 y 2005

OBJECTIVES: To investigate the associations between changes in indicators of health-related resources and coverage, and variations in infant mortality rates (IMR) in Brazil's 27 states in 2000 and 2005. METHODS: Data were obtained from the Ministry of Health's online database, DATASUS. Stepwise multiple regressions were performed to model changes in IMR and its components (early, late, and post-neonatal mortality), using changes in the selected health indicators as predictors. RESULTS: Regression analysis showed that improving access to prenatal care (B = -0.89 per 1 000; P < 0.001), increasing public expenditure on health as a proportion of gross domestic product (GDP) (B = -0.72 per 1 000; P = 0.031), and increasing access to the water supply (B = -0.22 per 1 000; P = 0.033) were associated with significant reductions in IMR. Declining early neonatal mortality rates were associated with prenatal care (B = -0.14 per 1 000; P = 0.026) and access to sanitation services (B = -0.05 per 1 000; P = 0.026). Reductions in late neonatal mortality rates were associated with prenatal care (B = -0.12 per 1 000; P = 0.003) and inversely correlated to the rate of cesarean deliveries (B = 0.13 per 1 000; P = 0.005). Post-neonatal mortality rate reductions were associated with prenatal care (B = -0.64 per 1 000; P < 0.001), increasing public expenditure on health as a proportion of GDP (B = -0.76 per 1 000; P = 0.005), and access to the water supply (B = -0.17 per 1 000; P = 0.037). CONCLUSIONS: Improving access to prenatal care, increasing public expenditure on health, and access to sanitation and water supply were all independently correlated to declining IMR; however, higher rates of cesarean deliveries were associated with higher late neonatal mortality rates. Continuous collection and analysis of relevant health indicators is recommended for developing evidence-based health policies and accurate predictions of how specific public health interventions...

OBJETIVOS: Investigar las asociaciones entre los cambios en los indicadores de recursos y cobertura relacionados con la salud y las variaciones en las tasas de mortalidad infantil (TMI) en los 27 estados de Brasil entre los años 2000 y 2005. MÉTODOS: Los datos se obtuvieron de la base de datos en línea del Ministerio de Salud, DATASUS. Mediante regresión múltiple paso a paso se modelaron los cambios en la TMI y sus componentes (mortalidades temprana, tardía y posneonatal), utilizando como predictores los cambios en indicadores seleccionados de salud. RESULTADOS: Según el análisis de regresión, el mejoramiento del acceso a la atención prenatal (B = -0,89 por 1 000; P < 0,001) y al suministro de agua (B = -0,22 por 1 000; P = 0,033), y el aumento del gasto público en salud como proporción del producto interno bruto (PIB) (B = -0,72 por 1 000; P = 0,031) se asociaron con reducciones significativas de las TMI. Las reducciones de las tasas de mortalidad neonatal temprana se asociaron con la atención prenatal (B = -0,14 por 1 000; P = 0,026) y el acceso a servicios de saneamiento (B = -0,05 por 1 000; P = 0,026). Las reducciones en las tasas de mortalidad neonatal tardía se asociaron con la atención prenatal (B = -0,12 por 1 000; P = 0,003) e, inversamente, con la tasa de partos por cesárea (B = 0,13 por 1 000; P = 0,005). Las reducciones en las tasas de mortalidad posneonatal se asociaron con la atención prenatal (B = -0,64 por 1 000; P < 0,001), el aumento en el gasto público en salud como proporción del PIB (B = -0,76 por 1 000; P = 0,005) y el acceso a fuentes de agua (B = -0,17 por 1 000; P = 0,037). CONCLUSIONES: El mejoramiento del acceso al cuidado prenatal, el incremento del gasto público en salud y el acceso al saneamiento y a fuentes de agua se correlacionaron independientemente con la reducción en las TMI; mayores tasas de partos por cesárea se asociaron con mayores tasas de mortalidad neonatal tardía. Se recomienda mantener la...

The impact of changing health indicators on infant mortality rates in Brazil, 2000 and 2005.

OBJECTIVES: To investigate the associations between changes in indicators of health-related resources and coverage, and variations in infant mortality rates (IMR) in Brazil's 27 states in 2000 and 2005. METHODS: Data were obtained from the Ministry of Health's online database, DATASUS. Stepwise multiple regressions were performed to model changes in IMR and its components (early, late, and post-neonatal mortality), using changes in the selected health indicators as predictors. RESULTS: Regression analysis showed that improving access to prenatal care (B = -0.89 per 1 000; P < 0.001), increasing public expenditure on health as a proportion of gross domestic product (GDP) (B = -0.72 per 1 000; P = 0.031), and increasing access to the water supply (B = -0.22 per 1 000; P = 0.033) were associated with significant reductions in IMR. Declining early neonatal mortality rates were associated with prenatal care (B = -0.14 per 1 000; P = 0.026) and access to sanitation services (B = -0.05 per 1 000; P = 0.026). Reductions in late neonatal mortality rates were associated with prenatal care (B = -0.12 per 1 000; P = 0.003) and inversely correlated to the rate of cesarean deliveries (B = 0.13 per 1 000; P = 0.005). Post-neonatal mortality rate reductions were associated with prenatal care (B = -0.64 per 1 000; P < 0.001), increasing public expenditure on health as a proportion of GDP (B = -0.76 per 1 000; P = 0.005), and access to the water supply (B = -0.17 per 1 000; P = 0.037). CONCLUSIONS: Improving access to prenatal care, increasing public expenditure on health, and access to sanitation and water supply were all independently correlated to declining IMR; however, higher rates of cesarean deliveries were associated with higher late neonatal mortality rates. Continuous collection and analysis of relevant health indicators is recommended for developing evidence-based health policies and accurate predictions of how specific public health interventions might impact IMR.

Predictive factors of chronic kidney disease in primary focal segmental glomerulosclerosis.

Renal histological features of focal segmental glomerulosclerosis (FSGS) are found in 75% of pediatric patients with steroid-resistant nephrotic syndrome. In order to evaluate the predictive factors of chronic kidney disease (CKD), we retrospectively reviewed the records of 110 children with biopsy-proven FSGS admitted between 1972 and 2004. Renal survival was analyzed by the Kaplan-Meier method and Cox's regression model. Two multivariate models were developed: (1) from the onset of symptoms to the occurrence of CKD and (2) from the time of renal biopsy to CKD. Mean follow-up time was 10 years [standard deviation ((SD) 5.5], and 24 patients (21.8%) progressed to CKD. At baseline, after adjustment three variables remained as independent predictors of CKD: age >6.5 years (RR=3.3, 95% CI=1.3-7.8), creatinine >1 mg/dl (RR=2.5, 95% CI=0.97-6.5), and non-response to steroids (RR=7.3, 95% CI=2.7-19.7). In a model with continuous variables only age and non-response to steroids were associated with CKD. At the time of renal biopsy, after adjustment two variables remained as independent predictors of CKD: hematuria (RR=3.0, 95% CI=1.2-7.3) and creatinine >0.8 mg/dl (RR=4.3, 95% CI=1.7-10.6). In a model with continuous variables four factors predicted CKD: age, creatinine, hematuria, and percentage of global sclerosis.

Clinical course of 110 children and adolescents with primary focal segmental glomerulosclerosis.

The purpose of this retrospective cohort study was to report the clinical course of children and adolescents with primary focal segmental glomerulosclerosis (FSGS). The records of 110 patients with biopsy-proven FSGS admitted between 1972 and 2004 were retrospectively reviewed. Demographic, clinical and laboratory data were recorded and histopathological data were reanalyzed by one pathologist who had no information about the outcome of the patients. Renal survival analysis was performed using the Kaplan-Meier method. Differences between subgroups (response to corticosteroids) were assessed by the two-sided log rank test. The median age at admission was 5 years (range: 1-15 years). Forty-two patients (38.2%) presented with hematuria at admission, and 55 (50%) presented blood pressure levels above the 95th percentile. Mean follow-up time was 10 years (SD 5.5). Twenty-four patients (21.8%) presented chronic kidney disease (CKD). It was estimated that the probability of CKD was 8% at 5 years, 17% at 10 years, and 32% at 15 years after diagnosis of nephrotic syndrome. In conclusion, on the basis of the clinical and histological characteristics observed, apparently our cohort of idiopathic FSGS is comparable with other published series. However, the long-term overall renal survival seems to be better in our cohort.

Prevalência de sobrepeso e obesidade em crianças e adolescentes das regiões Sudeste e Nordeste / Over weigt and obesity prevalence among children and adolescents from Northeast and Southeast regions of Brazil

Objetivo: estudar a prevalência de sobrepeso e obesidade em crianças e adolescentes da região Sudeste e Nordeste.Métodos: dados da pesquisa sobre padrões de vida, realizada pelo Instituto Brasileiro de Geografia e Estatística (IBGE) em 1997.Estudadas 3.317 crianças e 3.943 adolescentes agrupados em faixas etárias. Sobrepeso (adolescentes) e obesidade (crianças e adolescentes) foram definidos segundo recomendações da Organização Mundial de Saúde. Comparação de prevalências por faixa etária, sexo e região geográfica pelo teste z, considerando 0,05 como nível designificância estatística.Resultados:a prevalência de sobrepeso em adolescentes variou entre 1,7por cento no Nordeste, e 4,2por cento no Sudeste. A prevalência de obesidade em adolescentes variou entre 6,6por cento e 8,4por cento, e em crianças entre 8,2por cento e 11,9por cento, nas regiões Nordeste e Sudeste, respectivamente. Agrupando-se os dados das duas regiões, a prevalência no sexo feminino foi de 10,3por cento de obesidade entre crianças, 9,3por cento de obesidade e 3,0por cento de sobrepeso entre adolescentes. No sexo masculino, a prevalência foi de 9,2por cento, 7,3por cento e 2,6por cento, respectivamente.Conclusões: a prevalência de obesidade é menor no Nordeste, com significância estatística entre crianças e adolescentes com idade entre 2-17 anos. O mesmo ocorreu com a prevalência de sobrepeso entre os adolescentes. A diferença de prevalência de obesidade entre lactentes e adolescentes acima de 18 anos não foi estatisticamente significante. Entre lactentes, a obesidade é mais prevalente no sexo feminino

[Overweight and obesity prevalence among children and adolescents from Northeast and Southeast regions of Brazil]. / Prevalência de sobrepeso e obesidade em crianças e adolescentes das regiões Sudeste e Nordeste.

OBJECTIVE: To study the prevalence of obesity and overweight among children and adolescents from Northeast and Southeast regions of Brazil. METHODS: Data was collected form Life Pattern Research conducted by the Brazilian Institute of Geography and Statistics (IBGE) in 1997. A sample of 3,317 children and 3,943 adolescents was studied according age groups. Overweight (adolescents) and obesity (adolescents and children) were defined according to World Health Organization recommendations. Z-test was used to compare prevalence among age groups, sex and geographic region. The cut-off point for statistical significance was 0.05. RESULTS: Overweight prevalence in adolescents was 1.7% in Northeast and 4.2% in Southeast. Obesity prevalence in adolescents was 6.6% and 8.4% in children and 8.2% and 11.9% in Northeast and Southeast, respectively. Considering both regions prevalence of obese female children was 10.3%, the rate of obese adolescents was 9.3% and overweight adolescents represented 3.0%. Among males prevalence was 9.2%, 7.3% and 2.6%, respectively. CONCLUSIONS: Obesity prevalence is lower in Northeast than Southeast among children with age from 2 to 17 years old. Overweight prevalence among adolescents was also lower in Northeast than in Southeast. The prevalence of obesity among younger than 2 and older than 18 years old was the same. Obesity prevalence is higher among breast-fed females. Among other age groups prevalence of obesity and overweight was the same for males and females. It is difficult to compare these results with other studies, since there are few populational studies and the criteria used to define overweight and obesity in children and adolescents varies in each study.

Estudo descritivo de queimaduras em crianças e adolescentes / A descriptive study of burn inhjuries in children and adolescents

Objetivo: Investigar a freqüência das queimaduras, os fatores associados, as principais complicaçöes e a relaçäo com diversas variáveis. Métodos: Estudo descritivo, conduzido no Hospital Joäo XXIII (jan-dez/92), cuja amostra constituiu-se de 537 crianças e adolescentes. Resultados: 408 pacientes (76 por cento)eram crianças (<10 anos) e 129 (24 por cento) eram adolescentes (10-19). 398 acidentes (74 por cento) ocorreram dentro de casa, e destes 235 (59 por cento) na cozinha. 80 pacientes (15,0 por cento) foram internados. Constatou-se maior percentual de acidentes de ocorrência extra-domiciliar entre os pacientes admitidos (mais graves) em comparaçäo com aqueles do grupo tratado em ambulatório (p<0,05). Entre os pacientes admitidos, ocorreram sete casos de septicemia (9,0 por cento), a chama foi o agente predominante (p<0,01) e causou queimaduras mais extensas (p<0,05). Os dolescentes apresentaram maior extensäo de superioridade corporal queimada que as crianças (p<0,01). Em 290 casos (54 por cento) os familiares fizeram tratamento local com pomadas ou produtos caseiros e em 32 (6,0 por cento), banho local com água. A desidrataçäo foi a complicaçäo foi mais freqüênte ocorrendo em 28 pacientes (5,0 por cento). A permanência hospitalar média constatada no estudo de 30 ñ 33 dias. Conclusöes: A maioria das queimaduras consitui acidente doméstico, especialmente em menores de 7 anos; os líquidos quentqes säo os agentes mais comuns e a cozinha, a sede mais freqüênte. A chama ocupa o 1§ lugar em freqüência no adolescente e o 2§ na criança, determinando lesöes mais extensas e profundas. A desidrataçäo é a complicaçäo mais freqüênte na fase inicial, e as infecçöes, especialmente septicemia, nas fases subseqüêntes

Causas de internaçöes de crianças e adolescentes nos hospitais do SUS em Minas Gerais entre 1994 e 1995 / Admission causes of children and adolescents in Unified Health System hospitals, Minas Gerais state, from 1994 to 1995

O objetivo deste estudo foi determinar as causas mais freqüentes de internações de crianças e adolescentes nos hospitais do Estado de Minas Gerais conveniados ao SUS nos anos de 1994 e 1995. As informações sobre internações hospitalares foram obtidas através da "Autorização de Internação Hospitalar (AIH)" que os hospitais preenchem para receberem pelos serviços. Os dados dessas AIHs são disponibilizados pelo Ministério da Saúde (MS) através da rede BBS e CD-ROM. As variáveis estudadas foram a idade, sexo e a causa de internação. Em 1994 ocorreram 1.397.265 internações e em 1995, 1.465.389. Do total de internações no período, 18,6% correspondem a crianças e 9,5% a adolescentes. Predominaram as internações para o sexo masculino, exceto para os indivíduos com idades entre os 15 e 19 anos, faixa etária em que predominaram as internações relacionadas com a gestação (aproximadamente 60%). As doenças e infecções do aparelho respiratório constituíram a principal causa de internação em ambos os sexos e em todas as faixas etárias, com exceção somente para o sexo feminino na faixa etária de 15 a 19 anos. A segunda causa mais frequente correspondeu às doenças gastrointestinais em todas as faixas etárias e em ambos os sexos. Conclui-se que as informações do presente estudo contribuíram para o melhor conhecimento das principais causas de internações em crianças e adolescentes em hospitais credenciados pelo SUS em Minas Gerais, o que permitiria a implementação de ações e medidas preventivas do ponto de vista de saúde pública.

The objective of this study was to determine the most frequent causes of hospital admissions of children and adolescents in the Public Health Care System in the State of Minas Gerais in 1994 and 1995. Information about hospital admissions was obtained from the Hospital Admission Authorization forms (AIHs) filled by the hospitals for reimbursement, which are available through the BBS network and a CD-ROM distributed by the Ministry of Health. The studied variables were: age, sex and cause of admission. In 1994, 1,397,265 admissions ocurred and 1995, there were 1,465,389 admissions. During the period considered, 18,6% of the admissions corresponded to children and 9,5% to adolescents. Male admissions predominated except in individuals with ages between 15 and years. The main causes of admissions for both sex and all ages, corresponded to diseases and infections of the respiratory system except for the 15 to 19 year interval, in which female admissions predominated, pregnacy being the most frequent admission cause (60%). The second most frequent cause was gastrointestinal disease. It is concluded that the information of this study contributes to elucidate the main causes of admission of children and adolescents in hospital of the Public Health Care System, information that should allow the implementation of preventive actions of public health.