As causas de mortes evitáveis ou reduzíveis são definidas como aquelas preveníveis, total ou parcialmente, por ações efetivas dos serviços de saúde que estejam acessíveis em um determinado local e época. Essas causas devem ser revisadas à luz da evolução do conhecimento e tecnologia para prática da atenção à saúde. Portanto, este estudo está fundamentado em uma revisão da literatura referente à base conceitual e empírica das listas de causas de morte evitáveis, publicadas entre 1975 e 2004, e nas reflexões de um grupo de trabalho organizado pelo Ministério da Saúde do Brasil. O artigo propõe duas listas brasileiras desses eventos-para menores de cinco anos; e para pessoas com cinco ou mais anos de idade-, tendo por referência a tecnologia disponível no Sistema Único de Saúde (SUS). Embora esse debate se encontre em estágio inicial, seu aprofundamento parece promissor para o desenvolvimento metodológico do monitoramento e avaliação de desempenho da atenção à saúde no Brasil. Palavras-chave: causas de morte evitáveis; desempenho dos serviços de saúde; evitabilidade; mortes em menores de cinco anos de idade.

OBJECTIVE To analyze the prevalence and associated factors regarding the use of medicines by self-medication in Brazil.METHODS This cross-sectional population-based study was conducted using data from the PNAUM (National Survey on Access, Use and Promotion of Rational Use of Medicines), collected between September 2013 and February 2014 by interviews at the homes of the respondents. All people who reported using any medicines not prescribed by a doctor or dentist were classified as self-medication practitioners. Crude and adjusted prevalence ratios (Poisson regression) and their respective 95% confidence intervals were calculated in order to investigate the factors associated with the use of self-medication by medicines. The independent variables were: sociodemographic characteristics, health conditions and access to and use of health services. In addition, the most commonly consumed medicines by self-medication were individually identified.RESULTS The self-medication prevalence in Brazil was 16.1% (95%CI 15.0–17.5), with it being highest in the Northeast region (23.8%; 95%CI 21.6–26.2). Following the adjusted analysis, self-medication was observed to be associated with females, inhabitants from the North, Northeast and Midwest regions and individuals that have had one, or two or more chronic diseases. Analgesics and muscle relaxants were the therapeutic groups most used for self-medication, with dipyrone being the most consumed medicines. In general, most of the medicines used for self-medication were classified as non-prescriptive (65.5%).CONCLUSIONS Self-medication is common practice in Brazil and mainly involves the use of non-prescription medicines; therefore, the users of such should be made aware of the possible risks.

INTRODUÇÃO: Os dados apresentados fazem parte de um estudo multicêntrico sobre automedicação na América Latina realizado pela Organização Mundial de Saúde (OMS). Objetivou-se traçar um perfil da automedicação através da análise da procura de medicamentos em farmácias sem prescrição médica ou aconselhamento do farmacêutico/balconista. MATERIAL E MÉTODO: As especialidades farmacêuticas foram classificadas pelo código "Anatomical Therapeutical Classification" e analisadas sob quatro aspectos qualitativos: valor intrínseco, essencialidade (lista da OMS e Relação Nacional de Medicamentos Essenciais (RENAME), combinação em dose fixa e necessidade de prescrição médica. RESULTADOS: Foram solicitadas 5.332 especialidades farmacêuticas (785 diferentes princípios ativos), sendo 49,5% combinações em dose fixas, 53,0% de valor intrínseco não elevado, 44,1% sujeitos a prescrição médica, 71,0% não essenciais e 40,0% baseados em prescrições médicas anteriores. Os medicamentos mais solicitados foram analgésicos (17,3%), descongestionantes nasais (7,0%), antiinflamatório/antireumático e antiinfecciosos de uso sistêmico, ambos com 5,6%. CONCLUSÕES: Os dados sugerem que a automedicação no Brasil reflete as carências e hábitos da população, é consideravelmente influenciada pela prescrição médica e tem a sua qualidade prejudicada pela baixa seletividade do mercado farmacêutico.

Abstract. Although increases in severity of mortality from dengue infection have been observed in Brazil, their determinants are not fully known. A case-control study was conducted by using the National Notifiable Diseases Surveillance System, including patients with severe dengue during 2000-2005. Cases were defined as patients that died and controls were those who survived. Hierarchical multivariate logistic regression was performed. During the study period, there were 12,321 severe cases of dengue and 1,062 deaths. Factors independently associated with death included age 50 years (odds ratio [OR] = 2.29, 95% confidence interval [CI] = 1.59-3.29), 4 years of schooling (OR = 1.83, 95% CI = 1.47-2.28), a rural area (OR =2.84, 95% CI = 2.19-3.69), hospitalization (OR = 1.42, 95% CI = 1.17-1.73), and a high hematocrit (OR = 2.46, 95% CI = 1.85-3.28). Factors associated with a lower chance of dying were female sex (OR = 0.76, 95% CI = 0.67-0.87), history of previous dengue (OR = 0.78, 95% CI = 0.62-0.99), positive tourniquet test result (OR = 0.47, 95% CI = 0.33-0.66), laboratory diagnosis of dengue (OR = 0.75, 95% CI = 0.61-0.92), and a platelet count of 50,000-100,000 cells/mm 3 (OR = 0.56, 95% CI = 0.36-0.87). The risk profile identified in this study should serve to direct public health interventions to minimize deaths.

The objective of this work was to investigate the prevalence and determinants of medicines consumption in Fortaleza, Ceará, Brazil. A population-based cross-sectional study was carried out in a representative sample of 331 households. A total of 1,370 persons living in Fortaleza were interviewed from October 2002 to January 2003, and 1,366 were selected for this study. Consumers were defined as all persons having used one or more drugs during the preceding 15 days. The prevalence of medicine consumption was 49.7%. The following were the predictive factors for medicines consumption according to the multivariate logistic regression analysis: family income > 3 minimum wages, older age ( > or = 50), female gender, > or = 3 persons living in household, chronic disease, having a health insurance plan, and one or more visits to the doctor in the last three months. Prevalence of medication use was high in Fortaleza but was similar to that found elsewhere in Brazil and in other countries. Inequality in the access of medications was identified.

Os óbitos de menores de um ano foram classificados em causas evitáveis, mal definidas e não evitáveis empregando a Lista Brasileira de Mortes Evitáveis, entre 1997-2006. Foram calculados tendências dos coeficientes de mortalidade infantil por causas de morte e se usou regressão não linear para avaliação de tendência. As causas evitáveis e as causas mal definidas apresentaram significativa redução (p < 0,001). As causas reduzíveis de mortalidade apresentaram redução de 37%. A mortalidade por causas reduzíveis por adequada atenção ao parto declinou em 27,7%; adequada atenção ao recém-nascido, 42,5%; e por adequada atenção à gestação cresceu 28,3%. Concluiu-se que os serviços de saúde contribuíram para a redução da mortalidade infantil. O declínio das causas mal definidas de morte indica ampliação do acesso aos serviços de saúde. O aumento do acesso e atenção ao parto e aos cuidados com recém-nascido contribuíram para a redução de óbitos infantis. O aumento da mortalidade por adequada atenção à gestação revela a necessidade de aprimoramento da atenção pré-natal.

OBJECTIVE To analyze variations in the prevalence of chronic use of medicines by older adults in Brazil according to its possible association with the most prevalent chronic diseases and demographic and health factors, and to identify risk factors for polypharmacy.METHODS A study based on data from the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM), a cross-sectional, population-based survey with probability sampling in Brazilian urban areas. The independent variable was the number of chronic-use medicines taken by older adults, linked to eight chronic diseases investigated. The intervening variables were gender, age group, marital status, level of education, socioeconomic status, Brazilian region, body mass index, smoking, self-perceived health, hospitalization in the previous year and having health insurance, besides the investigated chronic diseases. A multivariable analysis identified risk factors for polypharmacy.RESULTS Prevalence of at least one chronic-use medicines among older adults was 93.0%. Of the total number of older adults, 18.0% used at least five medications (polypharmacy). Polypharmacy was higher among the oldest individuals (20.0%), in the South region (25.0%), in those with poor self-perceived health (35.0%), in obese individuals (26.0%), in those with reported health insurance (23.0%) or hospitalization in the previous year (31.0%), and among those who reported any of the investigated diseases, particularly diabetes (36.0%) and heart diseases (43.0%). The variables remaining in the final risk model for polypharmacy were age, region, perceived health, health insurance, hospitalization in the previous year and all investigated diseases except stroke.CONCLUSIONS Older adults with specific diseases have risk factors for polypharmacy modifiable by actions aimed at the rational use of medicines. With the current population aging and successful drug access policy, the trend is an increase in drug use by older adults, which should feature as a priority in the planning agenda of the Brazilian Unified Health System (SUS).

Abstractobjective To analyse the ecological association between the demographic and socio-economic characteristics of the Brazilian municipalities and average leprosy incidence rate in the period 2009-2011.methods An ecological study taking the Brazilian municipalities as its units of analysis. The local empirical Bayes estimation method was used to obtain smoothed incidence rates (SIR) for leprosy. The mean, median, first quartile (Q1) and third quartile (Q3) of the SIR were calculated per 100 000 inhabitants. Hierarchical log-linear negative binomial regression models were used to estimate the incidence rate ratios (IRR).