São Paulo de Olivença, Brazil
São Paulo de Olivença, Brazil

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Venancio S.I.,Institute Saude | Saldiva S.R.D.M.,Institute Saude | Monteiro C.A.,University of Sao Paulo
Revista de Saude Publica | Year: 2013

The objective of this study was to document the secular trend in breastfeeding in Brazil. Data bases from seven national surveys conducted from 1975 to 2008 were reanalyzed. To obtain compatible data from the different surveys, children in the same age group and the same indicators were analyzed, using the same statistical techniques. The median duration of breastfeeding increased from 2.5 to 11.3 months, and the prevalence of exclusive breastfeeding in infants under six months of age increased from 3.1% to 41.0% in the period. The results indicate important challenges in accelerating the rhythm at which this practice in Brazil moves towards meeting international recommendations.

Grangeiro A.,University of Sao Paulo | Escuder M.M.L.,Institute Saude | de Castilho E.A.,University of Sao Paulo
Cadernos de Saude Publica | Year: 2010

The aim of this study was to identify different profiles in the AIDS epidemic in Brazil by relating them to the health sector's organization, situations involving increased risk of infection, and the degree of implementation of the response by health services. The Brazilian municipalities (counties) were grouped according to the magnitude of the epidemic and its trends from 2002 and 2006, and were then studied using indicators obtained from secondary databases. Municipalities with large epidemics (39%) displayed more situations associated with risk of infection, and those with an upward trend in incidence (11.5%) showed a lower degree of response. Cities with large epidemics but with downward or stable trends had 68.6% of all the anonymous testing centers and 75.8% of the outpatient clinics, and performed 81.4% of all the HIV antibody tests in the health system. Preventive measures in schools and primary health services showed low coverage rates. Differences were observed between geographic regions. Inequalities in the degree of implementation of the response to HIV may contribute to different profiles in the epidemic around the country.

Grangeiro A.,University of Sao Paulo | Escuder M.M.L.,Institute Saude | de Castilho E.A.,University of Sao Paulo
Cadernos de Saude Publica | Year: 2011

The aim of this study was to evaluate strategies by the Brazilian Ministry of Health to expand the municipal response to AIDS. Cities "included" and "not included" in Federal strategies for "municipalization" of the response were compared according to the response profile and trends in the epidemic. Multinomial logistic regression was used, among other statistical procedures. Municipalities included from 1994 to 1998 showed higher chances of providing HIV diagnostic testing [OR = 15.0; 95%CI: 5.6-40.1], of having AIDS services [OR = 18.4; 95%CI: 8.4-40.5], and reducing cases involving heterosexual [OR = 3.1; 95%CI: 1.4-7.3], homosexual/bisexual [OR = 3.0; 95%CI: 1.4-6.2], and IDU transmission [OR = 6.6; 95%CI: 2.9-14.9] as compared to those "included in 2003" and "not included". There were no associations between the included Municipalities, greater coverage in prevention, the reduction in cases due to vertical transmission or blood transfusion, or mortality rates. Municipalities with a more structured response were associated with better results. The findings suggest that the municipalization policy contributed to improvement in the local response to AIDS.

Grangeiro A.,University of Sao Paulo | Escuder M.M.L.,Institute Saude | Castilho E.A.,University of Sao Paulo
Revista de Saude Publica | Year: 2010

Objective: To analyze different patterns of occurrence of AIDS in Brazilian cities between 2002 and 2006, associating trend and magnitude with sociodemographic indicators and local characteristics of the epidemic. Methods: This was an ecological study that categorized cities according to magnitude and trend of the epidemic and subsequently analyzed, considering social indicators, types of HIV transmission and year of first case reported. Data came from the Brazilian Epidemiological Surveillance System, the Brazilian Institute of Geography and Statistics and the United Nations Development Program for Brazil. Linear regression was used to estimate trend and chi-square statistics and ANOVA to analyze indicators. Results: A total of 4,190 cities (75.3%) reported AIDS cases between 2002 and 2006. Of these, 3,403 (81.2%) had an occurrence of "small magnitude" (mean = 4.7 cases), 367 (8.8%) of "average magnitude" (mean = 30.3 cases) and 420 (10.0%) of "great magnitude" (mean = 378.7 cases). Cases of "small magnitude" were associated with lower incidence; beginning of the epidemic after 1991; presence of one or two types of transmission; especially heterosexual contact; with occurrences of cases in one or two years of the period; and lower human development index (HDI). Those of a "great magnitude" were associated with larger cities and higher HDI; presence of all types of transmission; beginning of the epidemic between 1980/1991; and trend towards reduction/stabilization, especially due to a decrease in transmission among injecting drug users. Growth of the epidemic was concentrated in "small magnitude" cities, although without signifi cance to the point of changing proportional participation (8.7%) of these cities in the group of cases in Brazil. Conclusions: The AIDS epidemic remains concentrated in urban centers and the spread of cases to the countryside is characterized by irregular occurrence and small magnitude. Cities with low HDI and exclusive transmission through heterosexual contact showed low capacity of increase and the reduction of the epidemic is especially associated with the decrease in transmission among injecting drug users.

Venancio S.I.,Institute Saude | Saldiva S.R.D.M.,Institute Saude | Escuder M.M.L.,Institute Saude | Giugliani E.R.J.,Federal University of Rio Grande do Sul
Journal of Epidemiology and Community Health | Year: 2012

Background The Baby-Friendly Hospital Initiative (BFHI) has been implemented by WHO and Unicef with a view to protect, promote and support breast feeding. This paper aims to assess the influence of the BFHI on breastfeeding indicators in Brazil, using data from the 2nd Survey of Breastfeeding Prevalence, conducted in 2008. Methods Data on 64 municipalities were analysed: a total of 65 936 infants under the age of 1 year who were covered by the 2008 immunisation campaign. The outcomes of interest were breast feeding in the first hour of life in infants under 1 year of age; exclusive breast feeding on the first day after hospital discharge in infants under 4 months of age; exclusive breast feeding in infants under 2, 3 and 6 months of age; and pacifier use in infants under 6 months of age. The influence of birth in baby-friendly hospitals (BFHs) on these end points was analysed by means of Poisson regression with robust variance for complex samples. Findings Infants born in BFHs were 9% more likely to be breast fed in the first hour of life and 6% more likely to be breast fed on the first day at home. Exclusive breast feeding was 13%, 8% and 6% more likely in infants under the ages of 2, 3 and 6 months, respectively, born in BFHs. Birth in a BFH also correlated with significant less pacifier use. Conclusions The BFHI has had an impact on several indicators of breast feeding. The authors hope the results of this study will make policy makers and health professionals aware of the importance and potential of this strategy.

Venancio S.I.,Institute Saude | Escuder M.M.L.,Institute Saude | Saldiva S.R.D.M.,Institute Saude | Giugliani E.R.J.,Federal University of Rio Grande do Sul
Jornal de Pediatria | Year: 2010

Objectives: To present the breastfeeding (BF) indicators obtained in the Second Survey on Prevalence of Breastfeeding in the Brazilian Capitals and the Federal District and to analyze their evolution from 1999 to 2008. Methods: A cross-sectional study was conducted in children younger than 1 year old who participated in the second phase of the multivaccination campaign in 2008. We used two-stage cluster sampling. The questionnaire consisted of closed questions, including data on consumption of breast milk, other types of milk, and other foods on the day prior to the survey. We analyzed the prevalence of BF in the first hour of life; exclusive BF in children younger than 6 months; BF in children aged 9 to 12 months; and medians of exclusive BF and BF. The time variation of BF was established by comparing the medians of exclusive BF and BF in 1999 and 2008. Results: We obtained data from 34,366 children. We found that 67.7% (95%CI 66.7-68.8) of the children were breastfed in the first hour of life; the prevalence of exclusive BF in children aged 0 to 6 months was 41% (95%CI 39.7-42.4), while the prevalence of BF in children aged 9 to 12 months was 58.7% (95%CI 56.8-60.7). There was an increase of 30.7 days in the median duration of exclusive BF and 45.7 days in the median of BF. Conclusion: There was a significant improvement in the breastfeeding prevalence in the last decade. However, further efforts are required so that Brazil can reach BF rates compatible with the recommendations of the World Health Organization. Copyright © 2010 by Sociedade Brasileira de Pediatria.

Francisco P.M.S.B.,University of Campinas | Barros M.B.A.,University of Campinas | Segri N.J.,Federal University of Mato Grosso | Alves M.C.G.P.,Institute Saude
Revista de Saude Publica | Year: 2013

OBJECTIVE: To compare estimates obtained through household and telephone surveys for monitoring, intervention and development of health policies. METHODS: The study analyzed data from 2,526 and 1,900 individuals aged 18 and over, living in Campinas, SP, interviewed by the household survey (ISACamp) and by the telephone survey (Vigitel), respectively. Sex, age and schooling were used to characterize the studied population. Prevalence estimates and 95% confi dence intervals were utilized in the analysis. The estimates of the sociodemographic characteristics of the population were compared by t-test for two independent samples and the comparison of the other estimates, according to the type of survey, was performed using Poisson regression. RESULTS: No statistically signifi cant differences were found between the estimates obtained by the two surveys analyzed for overall prevalence of: overweight/obesity, smoking status, mammography in the prior year and Pap smear at least once in life. However, for the estimates of worse perceived health status, health plan affi liation, mammography at least once in life and Pap smear in the prior year, signifi cant differences were found, with a tendency to overestimate data from the telephone survey, except in the case of worse perceived health status. CONCLUSIONS: These fi ndings point to the need for further studies, which may contribute to a better understanding of the differences, given that telephone surveys can provide quick and essential information for monitoring modifi able risk factors for the assessment of interventions and to develop policies promoting health in Brazil.

Bersusa A.A.,Institute Saude
Revista brasileira de epidemiologia = Brazilian journal of epidemiology | Year: 2010

Arterial Hypertension (AH) and Diabetes Mellitus (DM) are considered a worldwide epidemics whose control poses a challenge to health care services. Within the National Health System, the Family Health Program currently has the dual role of being a system gateway and reference structure. Bearing in mind this scenario, this study assessed the access of AH and DM patients to health care and therapeutic drugs. A household survey was conducted in five municipalities with over 100,000 inhabitants in the Baixada Santista. A two-stage self-weighted probabilistic sample was used. Results estimated a prevalence of 26.3% for AH and of 8.8% for DM, AH being more prevalent among women. As to health care, 85.3% of the individuals with AH interviewed reported having had their arterial pressure checked, and 70.2% of those with DM reported having had their glucose blood serum level tested in the preceding six months. Drug treatment was prescribed to 99.4% of these patients, and 62.8% of AH patients purchased such drugs from private drugstores, and 57.9% of DM patients received drugs provided by health centers. Over 90% of the patients had no access to educational group activities, and 78% of AH and 92.5% of DM patients had no supervising home visits. These findings suggest the need for primary health care as the mainstay for the care provided to HA and DM.

Lima M.G.,University of Campinas | Barros M.B.A.,University of Campinas | Alves M.C.G.P.,Institute Saude
Cadernos de Saude Publica | Year: 2012

The objective was to identify factors associated with happiness in the elderly. A cross-sectional, population-based study was conducted in 1,431 elderly under the ISA-Camp 2008 project. The survey used a two-stage probabilistic cluster sample. Prevalence of happiness was measured over time according to socio-demographics variables, health behaviors, and health conditions. High prevalence of happiness was associated with: marital status (married), active working, activity and insufficient leisure-time activity, occasional consumption of alcoholic beverages, daily consumption of fruit, vegetables, and leafy vegetables, normal body mass index, and sleeping less than 10 hours/night and sleeping well. The highest prevalence of long-term happiness was observed among elderly with no reported illness, with better self-rated health, and with less disability. Happiness was strongly related to health indicators, suggesting the adequacy of complementary use of this indicator for evaluating health promotion programs in the elderly.

This paper focuses both the risk and the occurrence of non-planned pregnancy, abortions, as well as the awareness about and the use of emergency contraception among HIV/aids-infected women. A quantitative observational approach was used after a domiciliary survey in Santo Andre, São Paulo State, Brazil, where it was found that, after receiving the information about the infection, 62.8% adopted the use of male condom, 77.2% using it exclusively, 13% associated with hormone injections, and 9.8% alternated with either interrupted intercourse, fertility schedule or vaginal shower. Mechanical flaws by the use of the preservative occurred to 38%. Added to flaws associated to the alternation with behavioral methods, they caused together 40% of non-planned pregnancy, which occurred to 24% of the interviewed women, 22% resulting in self-provoked abortions. Emergency contraception was known by 51.4%, although only 2.7% had used it. The conclusion is that mechanical or behavioral flaws related to the use of preservative by HIV/aids-infected women increased their exposure to non-planned gestations and abortions. It is needed to amplify both the options and the supply of contraceptive methods, including emergency contraception, with constant re-orientation on the use of preservative among this public.

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