OBJECTIVE:To develop a diet quality index and to analyze socioeconomic factors associated with low child diet quality. METHODS:A cross-sectional study was performed with a representative sample of 1,282 children aged between seven and ten years, living in the city of Vitória, Southeastern Brazil, in 2007. Children were randomly selected from 26 public schools and six private schools. Data on socioeconomic characteristics and life habits of children were obtained from a structured questionnaire, sent to homes and preferably completed by mothers. A food frequency questionnaire was created from studies performed with Brazilian children and tested in a public school. An index entitled Índice de Alimentação do Escolar (ALES -School Child Diet Index) was designed to assess diet quality, taking in consideration the nutritional recommendations for the Brazilian population and the habit of having breakfast. The association between diet quality and socioeconomic factors was analyzed using multinomial logistic regression. Adjusted odds ratios and 95% confi dence intervals were estimated for the variables that remained in the model. RESULTS:According to the ALES index, approximately 41% of the children studied had low diet quality (boys= 37.7%, girls= 42.7%, p= 0.179). There were no signifi cant differences between sex, age, maternal employment status and living with the mother and diet quality. The variables that remained associated with low diet quality were low maternal level of education (OR= 3.93; 95% CI: 2.58;5.99), father not present in the household (OR= 2.03; 95% CI: 1.68;2.99) and not having lunch at the table (OR= 1.47; 95% CI: 1.12;1.93). CONCLUSIONS:Low maternal level of education increased the probability of a child not consuming a good quality diet, whether due to lack of access to healthy foods and adequate information or poorer ability to discern what is healthy.

This article describes the development of the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil) questionnaire. We fi rst address the selection of topics whose contents have to cover the knowledge available on the complex causal network of outcomes and allow comparability with similar studies. Then we deal with the "translation and adaptation of measurement instruments" including neighborhood environment rating scales, depression and anxiety disorder rating scale and a food frequency questionnaire and discuss criteria that guided "theme block sequencing". And fi nally we focus on the practical importance of "pretesting and pilot studies". The ELSA may provide an original contribution regarding factors that cause or aggravate the outcomes of interest in the Brazilian population, as well as protective factors. Good quality questionnaires are prerequisite to validity of study results. 5 Information from general objective questions (e.g., smoke/do not smoke) or questions on abstract concepts (e.g., job stress), collected using rating scales, can only be captured using a questionnaire as compared with assessments or measurements. A questionnaire can provide information on, for example, psychosocial aspects of childhood and adolescence or the respondent's perceived health. Understanding causal mechanisms of health outcomes as complex and comprehensive and determinants that are not closely related to the outcome of interest (e.g., parental education) have gained momentum in the investigation of chronic diseases. DESCRIPTORS:The questionnaire is a key component of the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil). The relationships of its contents and results of assessments and measurements can substantially contribute to understanding factors that may cause, aggravate or protect against cardiovascular diseases and type 2 diabetes in the Brazilian context. Potential variability of results between the six ELSA investigation centers in different Brazilian regions may improve the original contribution of the study. Bearing in mind distinctive characteristics of the Brazilian scenario, we opted to focus on social determinants of health. Capturing the potential impact of some factors (e.g., socioeconomic status), social and racial inequalities and health-related living conditions on outcomes of interest over the course of life may make the difference between what is already known and what the ELSA fi ndings can add to scientifi c knowledge. 1

O objetivo do estudo foi identificar a ocorrência simultânea de fatores de risco cardiovascular em crianças de 7 a 10 anos de Vitória, Espírito Santo, Brasil, e investigar variáveis socioeconômicas associadas. Foram pesquisadas 1.282 crianças e obtidos dados antropométricos e medidas da pressão arterial com aparelho automático. Dados socioeconômicos, de alimentação e de atividade física foram obtidos com base em questionário. Para avaliação da ocorrência simultânea de fatores de risco cardiovascular foi desenvolvido um índice a partir da presença de excesso de peso, pressão arterial elevada, alimentação de baixa qualidade e lazer sedentário > 4h/dia. Presença simultânea de quatro fatores de risco cardiovascular foi identificada como risco alto. Classe socioeconômica e escolaridade materna foram incluídas no modelo de regressão logística. Cerca de 34% das crianças apresentaram dois fatores de risco cardiovascular, 20% três fatores e 6,4 quatro fatores de risco cardiovascular. A escolaridade materna se manteve associada ao risco cardiovascular alto (OR: 7,36, IC95%: 2,09-25,97) e médio (OR: 2,57, IC95%: 1,58-4,20). Baixa escolaridade materna foi o fator mais importante associado ao risco cardiovascular.

Abstract

Objetivo: Descrever a série temporal das internações por condições sensíveis à atenção primária (ICSAP) no estado do Espírito Santo, no período de 2000 a 2014, segundo sexo, faixa etária, porte municipal, macrorregiões e grupos de causa, e investigar os fatores associados à ocorrência dessas hospitalizações. Métodos: Estudo ecológico de série temporal das ICSAP ocorridas de 2000 a 2014. A análise da série temporal foi realizada pelo método Cochrane-Orcutt, e para a análise de regressão multivariável multinível usou-se o modelo de regressão binomial negativa. Resultados: As ICSAP diminuíram 28,79% no período. As maiores taxas foram observadas entre os idosos e as crianças menores de cinco anos, e reduziram mais entre idosos e adultos. Os principais grupos de causas foram as gastroenterites infecciosas e complicações, a infecção no rim e trato urinário, e a insuficiência cardíaca. Houve redução das taxas de ICSAP na medida em que cresceu a taxa de cobertura da estratégia saúde da família (0,60, IC: 0,56-0,66), a proporção de médicos (0,90, IC: 0,84-0,96), de pretos e pardos (0,88, IC: 0,83-0,93) e de pessoas com ensino médio (0,87, IC: 0,76-0,99), enquanto houve acréscimo dessas hospitalizações a cada aumento do produto interno bruto per capita, do índice de Gini, da taxa de urbanização, dos leitos hospitalares e dos planos de saúde. Conclusão: A expansão e consolidação da estratégia saúde da família são importantes para a redução das ICSAP no estado dentre outros fatores, como recursos de saúde e fatores socioeconômicos. (39)1546 www.rbmfc.org.br ARTIGOS DE PESQUISAS Panorama de las hospitalizaciones por condiciones sensibles a la atención primaria en Espírito Santo, Brasil, 2000 a 2014Objective: To describe the time series of hospitalizations due to ambulatory care sensitive conditions (ACSC) in Espirito Santo, from 2000 to 2014, according to sex, age, municipal size, regions and cause groups, and investigate the factors associated with the occurrence of these hospitalizations. Method: Ecological study of time series of ACSC hospitalizations occurred from 2000 to 2014. The analysis of the time series was performed by the Cochrane-Orcutt method, and for the multivariable regression analysis the negative binomial regression model was used. Results: ACSC hospitalizations decreased 28.79% in the period. The highest rates were observed among the elderly and children under five, and decreased more among the elderly and adults. The main groups of causes were gastroenteritis and complications, infection in the kidney and urinary tract, and heart failure. There was a reduction in the ACSC hospitalizations rates as the coverage rate of family health strategy increased ( não se aplica. Conflito de interesses:declaram não haver.

O objetivo deste estudo foi investigar a associação entre a organização dos serviços de saúde e as taxas de internações hospitalares por condições sensíveis à atenção primária após ajuste para variáveis socioeconômicas e demográficas no contexto dos municípios do Espírito Santo, Brasil. Estudo ecológico das internações do Sistema Único de Saúde (SUS) com as variáveis: internações hospitalares por condições sensíveis à atenção primária, porte municipal, indicadores demográficos, socioeconômicos, organização e indicadores de desempenho dos serviços de saúde. Realizou-se análise multivariável por regressão de Poisson com ajuste robusto da variância. Foram ajustados modelos para a população total e por faixas etárias. Ordenaram-se as variáveis explicativas segundo modelo hierarquizado. Houve associação a risco de internações hospitalares por condições sensíveis à atenção primária com o percentual de analfabetismo (RR: 1,08-1,17), proporção de leitos SUS (RR: 1,09-1,12), urbanização (RR: 1,02-1,03), proporção de negros (RR: 0,97-0,98) e cobertura de plano de saúde (RR: 0,97-0,98). Há determinantes das internações hospitalares por condições sensíveis à atenção primária que implicam no padrão de utilização dos serviços e estão fora do escopo da atenção primária.

A study carried out with the objective of evaluating Orem's nursing self-care theory (TDAC) in women with hypertension. Four hypertensive women in an outpatient clinic were interviewed using a form with open and multiple-choice questions on conditioning factors and self-care requirements. The data were analyzed according to the TDAC theoretical framework. Based on the self-care requirements for hypertensive people, the existence or non-existence of adjustment between self-care capacity and self-care need as well as the inhibitors and enhancers of such adjustment were identified. It was concluded that TDAC allowed to identify important aspects related to hypertensive people which must be dealt with by nurses.

Recent studies have suggested the possible effect of dairy product intake on cardiovascular risk markers, including arterial stiffness. Our aim was to investigate whether dairy food intake is associated with arterial stiffness, which we assessed by carotid-femoral pulse wave velocity (cfPWV) and pulse pressure (PP) in a cross-sectional analysis of baseline data (2008–2010; n = 12,892) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Dairy consumption was evaluated with a validated food-frequency questionnaire (FFQ) by computing servings per day for total and subgroups of dairy products. Dairy consumption was described in four categories (≤1 serving/day to >4 servings/day). Covariance analysis (ANCOVA) was used to compare cfPWV across increasing intake of dairy food, adjusting for confounding factors, including non-dairy food groups. The intake of total dairy was inversely associated with cfPWV and PP (−0.13 m/s and −1.3 mmHg, from the lowest and to the highest category of dairy intake). Low-fat dairy, fermented dairy and cheese showed an inverse relationship with cfPWV and PP. These findings suggest a beneficial effect of dairy consumption to reduce arterial stiffness. However, further evidence from longitudinal studies or long-term intervention is needed to support reduction of cfPWV and PP mediating the beneficial effects of dairy products on cardiovascular health.