BackgroundThe demographic shift and epidemiologic transition in Brazil have drawn attention to ways of measuring population health that complement studies of mortality. In this paper, we investigate regional differences in healthy life expectancy based on information from the National Health Survey (PNS), 2013.MethodsIn the survey, a three-stage cluster sampling (census tracts, households and individuals) with stratification of the primary sampling units and random selection in all stages was used to select 60,202 Brazilian adults (18 years and over). Healthy life expectancies (HLE) were estimated by Sullivan’s method according to sex, age and geographic region, using poor self-rated health for defining unhealthy status. Logistic regression models were used to investigate socioeconomic and regional inequalities in poor self-rated health, after controlling by sex and age.ResultsWide disparities by geographic region were found with the worst indicators in the North and Northeast regions, whether considering educational attainment, material deprivation, or health care utilization. Life expectancy at birth for women and men living in the richest regions was 5 years longer than for those living in the less wealthy regions. Modeling the variation across regions for poor self-rated health, statistically significant effects (p < 0.001) were found for the North and Northeast when compared to the Southeast, even after controlling for age, sex, diagnosis of at least one non-communicable chronic disease, and schooling or socioeconomic class. Marked regional inequalities in HLE were found, with the loss of healthy life much higher among residents of the poorest regions, especially among the elderly.ConclusionsBy combining data on self-rated health status and mortality in a single indicator, Healthy Life Expectancy, this study demonstrated the excess burden of poor health experienced by populations in the less wealthy regions of Brazil. To mitigate the effects of social exclusion, the development of strategies at the regional level is essential to provide health care to all persons in need, reduce risk exposures, support prevention policies for adoption of healthy behaviors. Such strategies should prioritize population groups that will experience the greatest impact from such interventions.

Prevalence, associated factors, and limitations related to chronic back problems in adults and elderly in BrazilPrevalência, fatores associados e limitações relacionados ao problema crônico de coluna entre adultos e idosos no Brasil Prevalencia, factores asociados y limitaciones relacionadas con el problema crónico de columna entre adultos y ancianos en Brasil

OBJECTIVE To analyze the temporal evolution of the hospitalization of older adults due to ambulatory care sensitive conditions according to their structure, magnitude and causes.METHODS Cross-sectional study based on data from the Hospital Information System of the Brazilian Unified Health System and from the Primary Care Information System, referring to people aged 60 to 74 years living in the state of Rio de Janeiro, Souhteastern Brazil. The proportion and rate of hospitalizations due to ambulatory care sensitive conditions were calculated, both the global rate and, according to diagnoses, the most prevalent ones. The coverage of the Family Health Strategy and the number of medical consultations attended by older adults in primary care were estimated. To analyze the indicators’ impact on hospitalizations, a linear correlation test was used.RESULTS We found an intense reduction in hospitalizations due to ambulatory care sensitive conditions for all causes and age groups. Heart failure, cerebrovascular diseases and chronic obstructive pulmonary diseases concentrated 50.0% of the hospitalizations. Adults older than 69 years had a higher risk of hospitalization due to one of these causes. We observed a higher risk of hospitalization among men. A negative correlation was found between the hospitalizations and the indicators of access to primary care.CONCLUSIONS Primary healthcare in the state of Rio de Janeiro has been significantly impacting the hospital morbidity of the older population. Studies of hospitalizations due to ambulatory care sensitive conditions can aid the identification of the main causes that are sensitive to the intervention of the health services, in order to indicate which actions are more effective to reduce hospitalizations and to increase the population’s quality of life.

Resumo Revisão sistemática sobre fatores demográficos, socioeconômicos, comportamentais e antropométricos associados à hipertensão (HAS). Foram incluídos estudos observacionais, de populações com 18 anos ou mais, dos últimos dez anos, publicados em inglês, português ou espanhol das bases Pubmed, Web of Science, Scopus e Lilacs. Ao final, foram incluídos 42 artigos, a maioria do tipo seccional. A idade e o Índice de Massa Corporal (IMC) elevados foram os fatores relacionados à maior chance de ter HAS mais encontrados nos estudos. Outros fatores associados à HAS foram: sexo (masculino), escolaridade (menor escolaridade), renda (menor renda) e circunferência da cintura (elevada). Nunca ter fumado, nunca ter consumido álcool e ter cor branca apareceram como características relacionadas a menor chance de ter HAS. Assim, características demográficas, socioeconômicas, comportamentais e antropométricas são importantes fatores associados a maior chance de ter HAS na população adulta. Entretanto, enquanto a maioria dos fatores associados à HAS for passível de intervenção, serão necessárias políticas de promoção da saúde mais amplas para reduzir as desigualdades socioeconômicas na prevalência de hipertensão.

Reciis -Rev Eletron Comun Inf Inov Saúde. 2019 jan-mar.;13(1):134-157 | [www.reciis.icict.fiocruz.br] e-ISSN 1981-6278 ARTIGOS ORIGINAIS http://dx. ResumoO Brasil se destaca na América Latina pela alta institucionalização de políticas de proteção à pessoa idosa. Contudo, um problema para sua consolidação é a falta de indicadores para seu acompanhamento. O objetivo deste artigo é propor indicadores sensíveis às dimensões da saúde contempladas nas políticas em vigor voltadas para esta população. O estudo foi dividido em três etapas. Na primeira, foi traçado um panorama das políticas voltadas para a pessoa idosa e foram identificadas as diretrizes e metas comuns no que tange à saúde. Na segunda, foram selecionados indicadores sociais e de saúde para acompanhamento das áreas temáticas. Na terceira, foram calculados indicadores para o Brasil e suas grandes regiões. Considerando esta análise preliminar, podemos concluir que, apesar de ser possível calcular indicadores para o acompanhamento de políticas a partir das fontes de dados disponíveis, limitações concernentes à oportunidade dos dados, sua desagregabilidade e confiabilidade restringem sua utilização para o aprimoramento das políticas nacionais. Palavras-chave: Políticas públicas; Saúde do idoso; Indicadores; Avaliação em saúde; Saúde pública. Artigo original | Diretrizes e indicadores de acompanhamento das políticas de proteção à saúde da pessoa idosa no Brasil 135 Reciis -Rev Eletron Comun Inf Inov Saúde. 2019 jan-mar.;13(1) | [www.reciis.icict.fiocruz.br] e- AbstractThe high level of institutionalization of Brazilian social policies for the elderly stands out in Latin America. However, a problem underlying its consolidation is the lack of indicators for their monitoring and evaluation. This paper aims to propose indicators that are sensitive to the different dimensions of health policies carried out for this population. The study is divided in three stages of research. On the first it was outlined an overview of the main public health policies dedicated to the elderly and identified common guidelines and goals concerning health. On the second stage we selected social and health indicators to follow the thematic areas. The third stage consisted in calculating the indicators proposed for Brazil and its macroregions. Considering the preliminary analysis, we can conclude that although it is possible to calculate sensitive indicators to follow the health policies using data sources available in Brazil, limitations regarding the timeliness of the data, their disaggregability and reliability restrict their use in the improvement of public policies. ResumenBrasil se destaca en América Latina por la alta institucionalización de políticas de protección a los ancianos. Sin embargo, un problema para su consolidación es la falta de indicadores para su seguimiento y apreciación suya. El objetivo de este artículo es proponer indicadores sensibles a las dimensiones de salud de las políticas dirigidas a esta población. El estudio se dividió en tres etapas. en la primera, ha...

OBJECTIVES To estimate the healthy life expectancy at 60 years by sex and Federated States and to investigate geographical inequalities by socioeconomic status.METHODS Healthy life expectancy was estimated by the Sullivan method, based on the information of the National Survey on Health, 2013. Three criteria were adopted for the definition of “unhealthy state”: self-assessment of bad health, functionality for performing the activities of daily living, and the presence of noncommunicable disease with intense degree of limitation. The indicator of socioeconomic status was built based on the number of goods at household and educational level of the head of household. To analyze the geographical inequalities and socioeconomic level, inequality measures were calculated, such as the ratio, the difference, and the angular coefficient.RESULTS Healthy life expectancy among men ranged from 13.8 (Alagoas) to 20.9 (Espírito Santo) for the self-assessment criterion of bad health. Among women, the corresponding estimates were always higher and ranged from 14.9 (Maranhão) to 22.2 (São Paulo). As to the ratio of inequality by Federated State, the medians were always higher for healthy life expectancy than for life expectancy, regardless of the definition adopted for healthy state. Regarding the differences per Federated State, the healthy life expectancy was seven years higher in one state than in another. By socioeconomic status, differences of three and four years were found, approximately, between the last and first fifth, for men and women, respectively.CONCLUSIONS Despite the association of the mortality indicators with living conditions, the inequalities are even more pronounced when the welfare and the limitations in usual activities are considered, showing the necessity to promote actions and programs to reduce the socio-spatial gradient.

This article examines the strategy for construction of a System of Indicators for Monitoring the Public Policies and Health Situation of the Elderly (SISAP-Idoso). The System seeks to assess the production of health information with the political/institutional decision, serving as a management tool in the health of the elderly. Its focus is to meet the need of the Unified Health System municipal managers for information for planning and controlling health programs. The paper presents the methods used in the creation of the Conceptual Matrix for Health Dimensions and Conceptual Matrix for Monitoring and Evaluation of Policies. The first systematizes a panel of indicators to diagnose the health condition of the elderly, a procedure without which one cannot properly plan health actions. The second selects indicators to monitor implementation and evaluate the results of health policies and programs for the elderly. The System became an important tool to support the formulation and monitoring of health programs, particularly at the local level. Moreover, it is a powerful tool of social control and population empowerment. The full incorporation of the System depends on the consolidation of information and indicators as parts of the policy process.

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