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Purpose Health-related quality of life outcomes are increasingly used to monitor population health and health inequalities and to assess the (cost-) effectiveness of health interventions. The EQ-5D-5L has been included in the Belgian Health Interview Survey, providing a new source of population-based self-perceived health status information. This study aims to estimate Belgian population norms for the EQ-5D-5L by sex, age, and region and to analyze its association with educational attainment. Methods The BHIS 2018 provided EQ-5D-5L data for a nationally representative sample of the Belgian population. The dimension scores and index values were analyzed using logistic and linear regressions, respectively, accounting for the survey design. Results More than half of respondents reported problems of pain/discomfort, while over a quarter reported problems of anxiety/depression. The average index value was 0.84. Women reported more problems on all dimensions, but particularly on anxiety/depression and pain/discomfort, resulting in significantly lower index values. Problems with mobility, self-care, and usual activities showed a sharp increase after the age of 80 years. Consequently, index values decreased significantly by age. Lower education was associated with a higher prevalence of problems for all dimensions except anxiety/depression and with a significantly lower index value. Conclusion This paper presents the first nationally representative Belgian population norms using the EQ-5D-5L. Inclusion of the EQ-5D in future surveys will allow monitoring over time of self-reported health, disease burden, and health inequalities.

Background Compared to men, women live longer but have more years with disability. We assessed the contribution of gender differences in mortality and disability, total and by cause, to women’s excess unhealthy life years (ULYs). Methods We used mortality data for France 2008 from Eurostat, causes of death from the CépiDc-INSERM-database; and disability and chronic conditions data from the French Disability Health Survey 2008–09. ULYs were calculated by the Sullivan method. The contributions of mortality and disability differences to gender differences in ULY were based on decomposition analyses. Results Life expectancy of French women aged 50 was 36.3 years of which 19.0 were ULYs; life expectancy of men was 30.4 years of which 14.2 were ULYs. Of the 4.8 excess ULYs in women, 4.0 years were due to lower mortality. Of these 4.0 ULYs, 1.8 ULY originated from women’s lower mortality from cancer, 0.8 ULY from heart disease and 0.3 ULY from accidents. The remaining 0.8 excess ULY in women were from higher disability prevalence, including higher disability from musculoskeletal diseases (+1.8 ULY) and anxiety-depression (+0.6 ULY) partly offset by lower disability from heart diseases (−0.8 ULY) and accidents (−0.3 ULY). Conclusion Lower mortality and higher disability prevalence contributed to women’s longer life expectancy with disability. Women’s higher disability prevalence due to non-fatal disabling conditions was partly offset by lower disability from heart disease and accidents. Conditions differentially impact gender differences in ULY, depending on whether they are mainly life-threatening or disabling. The conclusions confirm the health-survival paradox.

Health is a complex concept. Health covers various domains including physical, mental and social health and each can be defined in different dimensions ranging from positive health, ill health, diseases, impairments, disability, and, more recently, frailty. Constructs of health and its dimensions have evolved over time from a pure medical model to more biopsychosocial models, linked to changes in societal challenges. Since there is no single measure of health, the range of measures tell (in)consistent stories about the health of the population as each cover different dimensions. Due to differences in objectives and settings, the operationalisation of health measures range from complex multiple question instruments to more parsimonious and even single item instruments. Although they vary substantially, most of these instruments are complementary and provide different insights to the health of populations. The chapter reviews existing methods of operationalising the concepts of health, disability, and frailty in population health research.

Objectives We investigated the potential impact of reduced tobacco use scenarios on total life expectancy and health expectancies, i.e., healthy life years and unhealthy life years. Methods Data from the Belgian Health Interview Survey 2013 were used to estimate smoking and disability prevalence. Disability was based on the Global Activity Limitation Indicator. We used DYNAMO-HIA to quantify the impacts of risk factor changes and to compare the “business-as-usual” with alternative scenarios. Results The “business-as-usual” scenario estimated that in 2028 the 15-year-old men/women would live additional 50/52 years without disability and 14/17 years with disability. The “smoking-free population” scenario added 3.4/2.8 healthy life years and reduced unhealthy life years by 0.79/1.9. Scenarios combining the prevention of smoking initiation with smoking cessation programs are the most effective, yielding the largest increase in healthy life years (1.9/1.7) and the largest decrease in unhealthy life years (− 0.80/− 1.47). Conclusions Health impact assessment tools provide different scenarios for evidence-informed public health actions. New anti-smoking strategies or stricter enforcement of existing policies potentially gain more healthy life years and reduce unhealthy life years in Belgium.

Population aging is accompanied by the burden of chronic diseases and disability. Chronic diseases are among the main causes of disability, which is associated with poor quality of life and high health care costs in the elderly. The identification of which chronic diseases contribute most to the disability prevalence is important to reduce the burden. Although longitudinal studies can be considered the gold standard to assess the causes of disability, they are costly and often with restricted sample size. Thus, the use of cross-sectional data under certain assumptions has become a popular alternative. Among the existing methods based on cross-sectional data, the attribution method, which was originally developed for binary disability outcomes, is an attractive option, as it enables the partition of disability into the additive contribution of chronic diseases, taking into account multimorbidity and that disability can be present even in the absence of disease. In this paper, we propose an extension of the attribution method to multinomial responses, since disability is often measured as a multicategory variable in most surveys, representing different severity levels. The R function constrOptim is used to maximize the multinomial log-likelihood function subject to a linear inequality constraint. Our simulation study indicates overall good performance of the model, without convergence problems. However, the model must be used with care for populations with low marginal disability probabilities and with high sum of conditional probabilities, especially with small sample size. For illustration, we apply the model to the data of the Belgian Health Interview Surveys.

Background Women report more disability than men perhaps due to gender differences in the prevalence of diseases and/or in their disabling impact. We compare the contribution of chronic diseases to disability in men and women in France, using a disability survey conducted in both private households and institutions, and we also examine the effect of excluding the institutionalized population. Methods Data comprised 17 549 individuals age 50+, who participated in the 2008–09 French Disability Health Survey including people living in institutions. Disability was defined by limitations in activities people usually do due to health problems (global activity limitation indicator). Additive regression models were fitted separately by gender to estimate the contribution of conditions to disability taking into account multi-morbidity. Results Musculoskeletal diseases caused most disability for both men (10.1%, CI: 8.1–12.0) and women (16.0%, CI 13.6–18.2). The second contributor for men was heart diseases (5.7%, CI: 4.5–6.9%), and for women anxiety-depression (4.0, CI 3.1–5.0%) closely followed by heart diseases (3.8%, CI 2.9–4.7%). Women’s higher contribution of musculoskeletal diseases reflected their higher prevalence and disabling impact; women’s higher contribution of anxiety-depression and lower contributions of heart diseases reflected gender differences in prevalence. Excluding the institutionalized population did not change the overall conclusions. Conclusions The largest contributors to the higher disability of women than men are moderately disabling conditions with a high prevalence. Whereas traditional disabling conditions such as musculoskeletal diseases are more prevalent and disabling in women, fatal diseases such as cardiovascular disease are also important contributors in women and men.

International audience; Background : We Aim :ed to investigate the contribution of chronic conditions to gender differences in disability-free life expectancy (DFLE) and life expectancy with disability (LED) in Belgium in 2001, 2004 and 2008. Methods: Data on disability and chronic conditions from participants of the 2001, 2004 and 2008 Health Interview Surveys in Belgium were used to estimate disability prevalence by cause using the attribution method. Disability prevalence was applied to life tables to estimate DFLE and LED using the Sullivan method. Decomposition techniques were used to assess the contribution of mortality and disability and further of causes of death and disability to gender disparities in DFLE and LED. Results: Higher LE, DFLE and LED were observed for women compared with men in all years studied. A decrease in the gender gap in LE (2001: 5.9; 2004: 5.6; 2008: 5.3) was observed in our cross-sectional approach followed by a decrease in gender differences in DFLE (2001: 1.9; 2004: 1.3; 2008: 0.5) and increase in LED (2001: 4.0; 2004: 4.4; 2008: 4.8). The higher LED in women was attributed to their lower mortality due to lung/larynx/trachea cancer, ischaemic heart diseases, and external causes (2001 and 2004) and higher disability prevalence due to musculoskeletal conditions (2008). Higher DFLE was observed in women owing to their lower mortality from lung/larynx/trachea cancer, ischaemic heart diseases, digestive cancer and chronic respiratory diseases. Conclusion: To promote healthy ageing of populations, priority should be given to reduce the LED disadvantage in women by targeting non-fatal diseases, such as musculoskeletal conditions.

BACKGROUND: This study aims to illustrate the differences between approaches proposed for apportioning disability to different diseases in a multicausal situation, i.e. the unadjusted attributable fraction (AF), the adjusted AF, the average AF and the attribution method (AM). This information is useful to better interpret results obtained from cross-sectional data and help policy makers decide on public health strategies. METHODS: Data for 29 931 individuals, representative of the French household population, who participated in the 2008-09 cross-sectional Disability-Health Survey, were included. Disability was defined as any limitation reported with the Global Activity Limitation Indicator. Unadjusted AFs were calculated using Levin's formula. Adjusted AFs were estimated for each disease by calculating predicted probabilities of disability for each individual in the dataset, under the assumption that the individual is unexposed to this specific disease (logistic model). Average AFs are based on the same methodology, but have the additional advantage that the average AFs for different diseases sum to the total AF associated with eliminating all diseases. AM accounts for competing risks and partitions total disability prevalence into additive contributions of different diseases and background disability (additive model). RESULTS: All methods obtained similar results with respect to the estimates of the disease contribution to disability prevalences and to ranking of the diseases, except unadjusted AFs, as the method ignores multimorbidity. Confounders other than diseases, such as age and gender, should be accurately taken into account. CONCLUSIONS: Conceptual differences, strengths and limitations of the different approaches were discussed.

Background This study aimed 1) to assess whether the contribution of chronic conditions to disability varies according to the educational attainment, 2) to disentangle the contributions of the prevalence and of the disabling impact of chronic conditions to educational disparities. Methods Data of the 2008–09 Disability Health Survey were examined (N = 23,348). The disability indicator was the Global Activity Limitation Indicator (GALI). The attribution method based on an additive hazard model was used to estimate educational differences in disabling impacts and in the contributions of diseases to disability. Counterfactual analyses were used to disentangle the contribution of differences in disease prevalence vs. disabling impact. Results In men, the main contributors to educational difference in disability prevalence were arthritis (contribution to disability prevalence: 5.7% (95% CI 5.4–6.0) for low-educated vs. 3.3% (3.0–3.9) for high-educated men), spine disorders (back/neck pain, deformity) (3.8% (3.6–4.0) vs. 1.9% (1.8–2.1)), chronic obstructive pulmonary diseases (2.4% (2.3–2.6) vs. 0.6% (0.5–0.7)) and ischemic heart /peripheral artery diseases (4.1% (3.9–4.3) vs. 2.4% (2.2–3.0)). In women, arthritis (9.5% (9.1–9.9) vs. 4.5%, (4.1–5.2)), spine disorders (4.5% (4.3–4.7) vs. 2.1% 1.9–2.3) and psychiatric diseases (3.1% (3.0–3.3) vs. 1.1% (1.0–1.3)) contributed most to education gap in disability. The educational differences were equally explained by differences in the disease prevalence and in their disabling impact. Conclusions Public health policies aiming to reduce existing socioeconomic disparities in disability should focus on musculoskeletal, pulmonary, psychiatric and ischemic heart diseases, reducing their prevalence as well as their disabling impact in lower socioeconomic groups. Electronic supplementary material The online version of this article (10.1186/s13690-018-0326-9) contains supplementary material, which is available to authorized users.

textabstractThe increase in life expectancy followed by the burden of chronic diseases contributes to disability at older ages. The estimation of how much chronic conditions contribute to disability can be useful to develop public health strategies to reduce the burden. This paper introduces the R package addhaz, which is based on the attribution method (Nusselder and Looman, 2004) to partition disability into the additive contributions of diseases using cross-sectional data. The R package includes tools to fit the additive hazard model, the core of the attribution method, to binary and multinomial outcomes. The models are fitted by maximizing the binomial and multinomial log-likelihood functions using constrained optimization. Wald and bootstrap confidence intervals can be obtained for the parameter estimates. Also, the contribution of diseases to the disability prevalence and their bootstrap confidence intervals can be estimated. An additional feature is the possibility to use parallel computing to obtain the bootstrap confidence intervals. In this manuscript, we illustrate the use of addhaz with several examples for the binomial and multinomial models, using the data from the Brazilian National Health Survey, 2013.

Background: Smoking is the leading cause of premature mortality and morbidity. This study aimed at assessing the impact of smoking on life expectancy (LE) and LE with (LED) and without disability (DFLE). We further estimated the contribution of disability and mortality and their causes to differences in LED and DFLE by smoking. Methods: Data on disability, chronic conditions, and smoking from 17 148 participants of the 1997, 2001, 2004 Belgian Health Interview Surveys were used to estimate causes of disability using the attribution method. A 10-year mortality follow-up of survey participants was used. The Sullivan method was applied to estimate LED and DFLE. The contribution of disability and mortality and of causes of disability and death to smoking differences in LED and DFLE was assessed using decomposition methods. Results: Never smokers live longer than daily smokers. DFLE advantage at age 15 of +8.5/+4.3 years (y) in men/women never compared with daily smokers was the result of lower mortality (+6.2y/+3y) and lower disability (2.3y/1.3y). The extra 0.3y/1.6y LED in never smokers was due to lower mortality (+2.6y/+2.9y) and lower disability (2.3y/1.3y). Lower mortality from lung/ larynx/trachea cancer, chronic respiratory, and ischaemic heart diseases was the main contributor to higher LED and DFLE in never smokers. Lower disability from musculoskeletal conditions in men and chronic respiratory diseases in women increased LED and DFLE in never smokers. Conclusions: Mortality and disability advantage among never smokers contributed to longer DFLE, while mortality advantage contributed to their longer LED.

Background GALI or Global Activity Limitation Indicator is a global survey instrument measuring participation restriction. GALI is the measure underlying the European indicator Healthy Life Years (HLY). Gali has a substantial policy use within the EU and its Member States. The objective of current paper is to bring together what is known from published manuscripts on the validity and the reliability of GALI. Methods Following the PRISMA guidelines, two search strategies (PUBMED, Google Scholar) were combined to identify manuscripts published in English with publication date 2000 or beyond. Articles were classified as reliability studies, concurrent or predictive validity studies, in national or international populations. Results Four cross-sectional studies (of which 2 international) studied how GALI relates to other health measures (concurrent validity). A dose-response effect by GALI severity level on the association with the other health status measures was observed in the national studies. The 2 international studies (SHARE, EHIS) concluded that the odds of reporting participation restriction was higher in subjects with self-reported or observed functional limitations. In SHARE, the size of the Odds Ratio’s (ORs) in the different countries was homogeneous, while in EHIS the size of the ORs varied more strongly. For the predictive validity, subjects were followed over time (4 studies of which one international). GALI proved, both in national and international data, to be a consistent predictor of future health outcomes both in terms of mortality and health care expenditure. As predictors of mortality, the two distinct health concepts, self-rated health and GALI, acted independently and complementary of each other. The one reliability study identified reported a sufficient reliability of GALI. Conclusion GALI as inclusive one question instrument fits all conceptual characteristics specified for a global measure on participation restriction. In none of the studies, included in the review, there was evidence of a failing validity. The review shows that GALI has a good and sufficient concurrent and predictive validity, and reliability.

Background The global phenomenon of population ageing is creating new challenges in both high and middle income countries, as functional limitations are expected to increase with age. The attribution method has been proposed to identify which conditions contribute most to disability using cross-sectional data. Although the original method was based on binary outcomes, we recently proposed an extension to multinomial responses, since different disability levels are often investigated in surveys. This is the first application of the extended method to evaluate differences in the contribution of chronic conditions to functional limitations in the older population of Brazil and Belgium. Methods Representative data from individuals aged ≥65 years who participated in the 2008 or 2013 Health Interview Surveys in Belgium (N = 4521) or in the 2008 National Household Sample Survey in Brazil (N = 28,437) were analysed. Individuals were classified as without, moderate or severe functional limitations, based on three activities of daily living: eating, showering, and toileting. Six chronic conditions common to the surveys – diabetes, heart diseases, musculoskeletal conditions, depression, chronic respiratory diseases, and cancer – were included in the analysis. Separate multinomial additive hazards models by gender for each country were fitted. Results The prevalence of moderate functional limitations was larger in men in Brazil (8.4%) compared to Belgium (6.0%) and similar in women (approximately 12.0%). Conversely, the severe prevalence in men was similar in the two countries (around 8.0%) and higher in women from Belgium (16.6%) than from Brazil (9.1%). Musculoskeletal conditions were the main contributors to the prevalence of functional limitations in men and women in Belgium but only in men and women with moderate functional limitations in Brazil. Depression and heart diseases contributed most to the severe prevalence of functional limitations in men and women in Brazil, respectively. Conclusions Our findings provide a better understanding of differences in the prevalence of different levels of functional limitations in Brazil and Belgium. These differences can be related to differences in socioeconomic conditions, health care access and quality, disease diagnosis, stage of epidemiology transition, life expectancy, and the prevalence of lifestyle risk factors in the two countries. Electronic supplementary material The online version of this article (10.1186/s13690-017-0235-3) contains supplementary material, which is available to authorized users.

Objectives: To assess the contribution of chronic conditions to the disability burden in the older men and women in Brazil. Methods: Data from 10,290 participants of the Brazilian National Health Survey in 2013 aged 60 years or older were used. Disability was defined based on limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL). Binomial additive hazards models were fitted to assess the contribution of chronic conditions to the disability prevalence. Results: Back pain was the most common condition, followed by diabetes and heart diseases in men and arthritis and diabetes in women. Stroke and mental disorders were by far the most disabling conditions in men and women. A higher disability prevalence was observed in women (34.4 %, CI 32.4; 36.2 %) compared to men (28.4 %; CI 25.9; 30.8 %). The most important contributors to the disability prevalence were stroke, back pain, and arthritis among men, and diabetes, heart diseases, and arthritis in women. Conclusions: Interventions to reduce disability in the older population in Brazil should take into account the gender gap in the occurrence of chronic conditions, focusing on the main contributors to the disability burden.

O objetivo foi analisar a tendencia de indicadores do tabagismo nas capitais brasileiras, segundo dados do Sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas por Inquerito Telefonico (VIGITEL) em adultos, 2006 a 2011. Foi utilizado modelo de regressao linear simples (a = 5%). Houve reducao da prevalencia de fumantes e fumantes pesados entre homens e entre individuos com idade de 35 a 54 anos. Para fumantes, tambem houve reducao no estrato de 9 a 11 anos de estudo e regioes Norte e Centro-oeste. Para fumantes pesados, a queda foi na Regiao Nordeste. A politica regulatoria adotada pelo Brasil tem sido responsavel pelo declinio nas prevalencias do tabaco.

Analisar a tendência da frequência do consumo do feijão nos anos de 2006 a 2009 nas capitais brasileiras. Trata-se de uma série histórica utilizando a base de dados do Vigitel de todas as capitais brasileiras. O consumo de feijão foi descrito por meio da frequência relativa e a tendência foi avaliada utilizando-se regressão de Poisson. O consumo de feijão cinco ou mais vezes por semana variou de 71,85% (2006) a 65,79 (2009). Na maior faixa de frequência de consumo ao longo de todo o período estudado estão incluídas as capitais Goiânia, Belo Horizonte, Palmas, Cuiabá e Brasília. As pessoas com IMC na categoria adequado/baixo peso apresentaram as maiores frequências de consumo em relação aos indivíduos com sobrepeso e obesidade. Foi observada tendência significativa de redução do consumo regular de feijão segundo ano de realização da pesquisa, exceto para a categoria de idade entre os 45 e 54 anos. Ocorreu redução significativa da frequência do consumo do feijão pela população brasileira e a adoção de políticas de monitoramento e incentivo do consumo é necessária em função dos benefícios apresentados pela leguminosa.The scope of this paper was to analyze the trends of frequency of consumption of beans between the years 2006 and 2009 in the Brazilian capitals. This is a historical series using the Vigitel database for all Brazilian state capitals. Consumption of beans was described in terms of relative frequency and the trend was assessed using Poisson regression. Between 65.79% (2009) and 71.85% (2006) of participants reported consuming beans five or more days per week. The capitals Goiania, Belo Horizonte, Palmas, Brasilia and Cuiaba were in the highest frequency range of consumption throughout the study period. Individuals with a BMI in the appropriate and low weight category had the highest frequencies of consumption in comparison with the overweight and the obese. A significant reduction trend in the consumption of beans per year of the research, except for the 45 to 54-year-old range, was detected. The conclusion drawn was that there has been a significant reduction in the consumption of beans in the Brazilian population and the adoption of monitoring and incentive policies is necessary due to the benefits of the legume.

BACKGROUND: The increase in longevity along with a high prevalence of chronic conditions contribute to increased disability burden. Despite the high occurrence of multimorbidity observed in advanced ages, most studies are restricted to the investigation of individual diseases. In this study, we assessed the impact of chronic conditions and multimorbidity on the disability burden in the older population in Belgium. METHODS: Data from 9,482 participants in the 2001, 2004, or 2008 Belgian Health Interview Surveys aged 55 years or older were analyzed. Disability was defined based on the Global Activity Limitation Indicator (GALI). To attribute disability to single chronic conditions and disease pairs, a multiple additive hazard model was fitted. RESULTS: Musculoskeletal conditions (45.3%), chronic respiratory diseases (11.2%), and cardiovascular diseases (10.2%) diseases were the most frequent conditions. Cardiovascular diseases, the co-occurrence of chronic respiratory diseases and depression, neurological diseases, cancer, and the combination of diabetes and cardiovascular diseases were the top five disabling conditions. The disability prevalence in the older population in Belgium was 35.6% (confidence interval =35.0; 36.2%). The most important contributors to the disability burden were musculoskeletal, cardiovascular, and chronic respiratory diseases. CONCLUSIONS: The present findings provide a deeper understanding of the role of chronic conditions and multimorbidity on the disability burden in the older population in Belgium. Although the disease pairs showed a low contribution to the disability burden, their occurrence presented a high impact on disability. Prevention strategies to tackle disability should target the main contributors to the disability burden and the most disabling conditions/disease pairs, especially in the clinical practice., Background. The increase in longevity along with a high prevalence of chronic conditions contribute to increased disability burden. Despite the high occurrence of multimorbidity observed in advanced ages, most studies are restricted to the investigation of individual diseases. In this study, we assessed the impact of chronic conditions and multimorbidity on the disability burden in the older population in Belgium. Methods. Data from 9,482 participants in the 2001, 2004, or 2008 Belgian Health Interview Surveys aged 55 years or older were analyzed. Disability was defined based on the Global Activity Limitation Indicator (GALI). To attribute disability to single chronic conditions and disease pairs, a multiple additive hazard model was fitted. Results. Musculoskeletal conditions (45.3%), chronic respiratory diseases (11.2%), and cardiovascular diseases (10.2%) diseases were the most frequent conditions. Cardiovascular diseases, the co-occurrence of chronic respiratory diseases and depression, neurologicaldiseases, cancer, and the combination of diabetes and cardiovascular diseases were the top five disabling conditions. The disability prevalence in the older population in Belgium was 35.6% (confidence interval =35.0; 36.2%). The most important contributors to the disability burden were musculoskeletal, cardiovascular, and chronic respiratory diseases. Conclusions. The present findings provide a deeper understanding of the role of chronic conditions and multimorbidity on the disability burden in the older population in Belgium. Although the disease pairs showed a low contribution to the disability burden, their occurrence presented a high impact on disability. Prevention strategies to tackle disability should target the main contributors to the disability burden and the most disabling conditions/disease pairs, especially in the clinical practice.

OBJETIVO: descrever os principais fatores de risco e proteção para doenças crônicas com dados do inquérito telefônico de 2010. METODOLOGIA: entrevistas telefônicas realizadas em amostra probabilística dos adultos residentes nas capitais do Brasil e Distrito Federal com telefone fixo residencial. As prevalências foram estratificadas por sexo, idade e escolaridade. RESULTADOS: Foi verificado alto consumo de refrigerantes (28%), de carne com gordura (46%) e de consumo abusivo de álcool (18%), e baixo consumo de frutas e hortaliças (18%) e de atividade física no lazer (15%). Aproximadamente metade da população referiu ter excesso de peso e não se proteger da radiação solar. A inatividade física e o tabagismo atingem cerca de 15% dos adultos. Fatores de risco foram mais prevalentes em homens, adultos jovens e de menor escolaridade. CONCLUSÃO: os resultados apontam diferentes comportamentos em saúde da população segundo características sociodemográficas. Essa variabilidade deve ser considerada nas ações de promoção de saúde.PURPOSE: To describe protection from chronic diseases and the prevalence of risk factors with data from a telephone survey in 2010. METHODS: Telephone interviews in a random sample of adults living in Brazilian state capitals and the Federal District with residential landline telephones. The prevalence of these factors was stratified by sex, age and level of education. RESULTS: High prevalence of soft drink consumption (28.1%), fatty meat consumption (34.2%), and alcohol abuse (18%) and low fruit and vegetable intake (18%) and leisure time physical activity (15%) was verified. Approximately half the population was overweight and reported no sun protection practices. Physical inactivity and smoking afflicted almost 15% of adults. In general, risk factors were more prevalent in men, predominantly young adults with lower education levels. CONCLUSION: The results revealed differing health behavior according to socio-demographic variables. These variables should be taken into consideration in health promotion campaigns.

Background Age-associated disability reduces quality of life in older populations and leads to wide-range implications for social and health policy. The identification of diseases that contribute to the disability burden is crucial to the development of prevention and intervention strategies to reduce disability. In this study, we assessed the contribution of chronic diseases to the prevalence of disability in Belgium. Methods Data from 35,837 individuals aged 15 years or older who participated in the 1997, 2001, 2004, or 2008 Belgian Health Interview Surveys were used. Disability was defined as difficulties in doing at least one of six activities of daily living (transfer in and out of bed, transfer in and out of chair, dressing, washing hands and face, feeding, and going to the toilet) and/or mobility limitations (ability to walk without stopping less than 200 m). Multiple additive regression models were fitted separately for men and women to estimate the age-specific background disability rate (experienced by everyone, independent of the presence of specific diseases) and disease-specific disability rates (disability rate in subjects who reported selected chronic diseases). Results Musculoskeletal, cardiovascular, and respiratory diseases were the main contributors to the disability burden in Belgium. Musculoskeletal diseases were the most prevalent diseases in men and women in all age groups. Neurological diseases and stroke were the most disabling diseases, i.e. caused the highest level of disability among the diseased individuals, in all age groups for men and women, respectively. Back pain was the main cause of disability in men aged 15 to 64 years, while heart attack was the major contributor to the disability prevalence in men aged 65 or older. Likewise, arthritis was the main cause of disability among women across all age groups. Depression was also an important contributor in young subjects (15–54 years). Cancer was not an important contributor to the disability prevalence in Belgium. Conclusions To reduce the burden of disability in Belgium, interventions should target musculoskeletal, cardiovascular and respiratory diseases especially among elderly. Furthermore, attention should also be given to depression in young individuals. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1574-z) contains supplementary material, which is available to authorized users.

A captação de sintomáticos respiratórios (SR) é importante para a detecção precoce de tuberculose. O objetivo deste estudo foi estimar a prevalência de SR em três regiões administrativas (RA) do Distrito Federal, Brasil. Para tanto, foi utilizada a técnica de amostragem por conglomerados (30 por 7) proposta pela Organização Mundial da Saúde. Foram definidos como SR os indivíduos com 15 anos ou mais residentes nas RAs Estrutural, Itapoã ou Varjão e que apresentassem tosse há pelo menos 3 semanas na data da entrevista. A prevalência de SR em Estrutural e Varjão foi de 5,7% (IC95%: 2,4 a 9,0), e em Itapoã, de 4,8% (IC95%: 1,6 a 7,9), com efeito de desenho próximo de 1,0. Em Estrutural e Itapoã, menos anos de estudo, e em Itapoã e Varjão, menor renda, estiveram associados com ser SR. O tabagismo esteve associado com a presença de sintomas respiratórios em todas as RAs. A prevalência de SR está de acordo com aquela encontrada em outras áreas com perfil socioeconômico semelhante ao das áreas estudadas.The identification of individuals with respiratory symptoms (RS) is important for the early detection of tuberculosis. The aim of this study was to estimate the prevalence of RS in three administrative regions of the Federal District, Brazil. For this, we used the 30 by 7 cluster sampling technique proposed by the World Health Organization. Individuals with RS were defined as those aged 15 years or older living in the administrative regions of Estrutural, Itapoã, or Varjão and reporting a cough lasting at least 3 weeks at the date of the interview. The prevalence of RS was 5.7% in Estrutural and Varjão (95% CI: 2.4-9.0) and 4.8% in Itapoã (95%CI: 1.6-7.9), with a design effect close to 1.0. In Estrutural and Itapoã, fewer years of schooling, and in Itapoã and Varjão, lower income, were associated with RS. Cigarette smoking was associated with the presence of RS in all regions. The prevalence of RS in the three administrative regions investigated is consistent with that of other areas with a similar socioeconomic profile.

To identify risk factors for death from pandemic (H1N1) 2009, we obtained data for 157 hospitalized patients with confirmed cases of this disease. Multivariate analysis showed that diabetes and class III obesity were associated with death. These findings helped define priority vaccination groups in Brazil.

The triads method is applied in validation studies of dietary intake to evaluate the correlation between three measurements (food frequency questionnaire, reference method and biomarker) and the true intake using validity coefficients (ρ). The main advantage of this technique is the inclusion of the biomarker, which presents independent errors compared with those of the traditional methods. The method assumes the linearity between the three measurements and the true intake and independence between the three measurement errors. Limitations of this technique include the occurrence of ρ > 1, known as “Heywood case”, and the existence of negative correlations, which do not allow the calculation of ρ. The objective of this review is to present the concept of the method, describe its application and examine the validation studies of dietary intake that use the triads method. We also conceptualize the “bootstrap” method, used to estimate the confidence intervals of the validity coefficients. ______________________________________________________________________________________________________________ RESUMO O método das tríades vem sendo utilizado em estudos de validação do consumo alimentar para avaliação da correlação entre três variáveis (questionário de freqüência alimentar, método de referência e biomarcador) e a ingestão real, por meio dos coeficientes de validade (Á). A principal vantagem deste método é a inclusão do biomarcador, que apresenta erros independentes dos métodos tradicionais. Os pressupostos desta técnica são a linearidade entre as três variáveis e a ingestão real, e a existência de erros independentes entre as variáveis. Entre as limitações deste método, destaca-se a existência de Á > 1, conhecido como "Heywood case", e de correlações negativas, que não permitem o cálculo do Á. O objetivo deste trabalho foi apresentar o conceito do método, descrever a sua aplicação e examinar estudos de validação do consumo alimentar que utilizaram o método das tríades, além de conceituar o método "bootstrap" para obtenção de intervalos de confiança dos coeficientes de validade.

OBJETIVO: Analisar e comparar o conhecimento sobre nutrição de professores e alunos do Projeto "a escola promovendo hábitos alimentares saudáveis", submetidos a duas estratégias de educação nutricional em escolas do Distrito Federal. MÉTODOS: O Projeto Escola utilizou duas estratégias de intervenção em educação nutricional: intervenção nutricional (A) ações educativas realizadas na comunidade escolar pela equipe; e intervenção nutricional (B) ações educativas desenvolvidas por professores que frequentaram oficinas de capacitação. O conhecimento das crianças foi avaliado por meio de um instrumento sobre pirâmide dos alimentos e um sobre higiene pessoal; sendo aplicado com os professores um questionário do tipo verdadeiro ou falso. RESULTADOS: Foram avaliadas 4 escolas com intervenção A (180 alunos e 19 professores) e 4 com intervenção B (129 alunos e 16 professores). A média de acertos no instrumento de pirâmide dos alimentos foi de 3,2 e 2,9 (p=0,37), respectivamente pelas crianças que receberam as intervenções nutricionais A e B. Na atividade sobre higiene pessoal, para estes mesmos alunos, observaram-se percentuais de acerto de 61,1% e 73,6% (p=0,10). Os professores que receberam as intervenções nutricionais A e B obtiveram percentuais de acertos semelhantes nos questionários, em torno de 90,0% (p=0,06). CONCLUSÃO: Observou-se que os dois tipos de intervenção de educação nutricional foram igualmente úteis para promover o conhecimento de alunos e professores. Portanto, faz-se necessário incentivar a realização de processos de educação nutricional no ambiente escolar, de acordo com a diretriz da Política Nacional de Alimentação e Nutrição que diz respeito à promoção da saúde.OBJECTIVE: The objective of this study was to analyze and compare the nutrition knowledge of teachers and students who participated in the study "Promotion of healthy eating habits by schools" and were submitted to two different strategies of nutrition education in schools of the Federal District, Brazil. METHODS: The study administered two strategies of nutrition education intervention: nutrition intervention (A) administration of educational activities in the school community by the research team; and nutrition intervention (B) educational activities were administered by teachers who participated in the training workshops..The knowledge of the students was assessed by an instrument based on the food pyramid and another one based on personal hygiene. The teachers were assessed by means of a true-or-false questionnaire. RESULTS: Four schools submitted to nutrition intervention A (180 students and 19 teachers) and four schools submitted to nutrition intervention B (129 students and 16 teachers) were assessed. The average number of correct answers given by the students on the instrument based on the food pyramid was 3.2 for students in intervention A and 2.9 for students in intervention B (p=0.37). On the instrument about personal hygiene for the same students, 61.1% and 73.6%, respectively, answered it correctly (p=0.10). The teachers submitted to interventions A and B answered a similar number of questions correctly, around 90.0% (p=0.06). CONCLUSION: This study showed that two different types of nutrition education intervention were equally useful to promote nutrition knowledge among teachers and students. Therefore, it is necessary to promote nutrition education programs in schools, in accordance with the National Food and Nutrition Policies, which regard health promotion strategies.

Population aging accompanied by an increased longevity with disability has raised international concern, especially due to its costs to the health care systems. Chronic diseases are the main causes of physical disability and their simultaneous occurrence in the population can impact the disablement process, resulting in different severity levels. In this study, the contribution of chronic diseases to both mild and severe disability burden in Belgium was investigated. Data on 21 chronic diseases and disability from 35,799 individuals aged 15 years or older who participated in the 1997, 2001, 2004, or 2008 Belgian Health Interview Surveys were analysed. Mild and severe disability were defined based on questions related to six activities of daily living and/or mobility limitations. To attribute disability by severity level to selected chronic diseases, multiple additive hazard models were fitted to each disability outcome, separately for men and women. A stable prevalence of mild (5 %) and severe (2-3 %) disability was observed for the Belgian population aged 15 years or older between 1997 and 2008. Arthritis was the most important contributor in women with mild and severe disability. In men, low back pain and chronic respiratory diseases contributed most to the mild and severe disability burden, respectively. The contribution also differed by age: for mild disability, depression and chronic respiratory diseases were important contributors among young individuals, while heart attack had a large contribution for older individuals. For severe disability, neurological diseases and stroke presented a large contribution in young and elderly individuals, respectively. Our results indicate that the assessment of the contribution of chronic diseases on disability is more informative if different levels of disability are taken into consideration. The identification of diseases which are related to different levels of disability - mild and severe - can assist policymakers in the definition and prioritisation of strategies to tackle disability, involving prevention, rehabilitation programs, support services, and training for disabled individuals., Background Population aging accompanied by an increased longevity with disability has raised international concern, especially due to its costs to the health care systems. Chronic diseases are the main causes of physical disability and their simultaneous occurrence in the population can impact the disablement process, resulting in different severity levels. In this study, the contribution of chronic diseases to both mild and severe disability burden in Belgium was investigated. Methods Data on 21 chronic diseases and disability from 35,799 individuals aged 15 years or older who participated in the 1997, 2001, 2004, or 2008 Belgian Health Interview Surveys were analysed. Mild and severe disability were defined based on questions related to six activities of daily living and/or mobility limitations. To attribute disability by severity level to selected chronic diseases, multiple additive hazard models were fitted to each disability outcome, separately for men and women. Results A stable prevalence of mild (5 %) and severe (2–3 %) disability was observed for the Belgian population aged 15 years or older between 1997 and 2008. Arthritis was the most important contributor in women with mild and severe disability. In men, low back pain and chronic respiratory diseases contributed most to the mild and severe disability burden, respectively. The contribution also differed by age: for mild disability, depression and chronic respiratory diseases were important contributors among young individuals, while heart attack had a large contribution for older individuals. For severe disability, neurological diseases and stroke presented a large contribution in young and elderly individuals, respectively. Conclusions Our results indicate that the assessment of the contribution of chronic diseases on disability is more informative if different levels of disability are taken into consideration. The identification of diseases which are related to different levels of disability – mild and severe – can assist policymakers inthe definition and prioritisation of strategies to tackle disability, involving prevention, rehabilitation programs, support services, and training for disabled individuals.

Analisar a tendência da frequência do consumo do feijão nos anos de 2006 a 2009 nas capitais brasileiras. Trata-se de uma série histórica utilizando a base de dados do Vigitel de todas as capitais brasileiras. O consumo de feijão foi descrito por meio da frequência relativa e a tendência foi avaliada utilizando-se regressão de Poisson. O consumo de feijão cinco ou mais vezes por semana variou de 71,85% (2006) a 65,79 (2009). Na maior faixa de frequência de consumo ao longo de todo o período estudado estão incluídas as capitais Goiânia, Belo Horizonte, Palmas, Cuiabá e Brasília. As pessoas com IMC na categoria adequado/baixo peso apresentaram as maiores frequências de consumo em relação aos indivíduos com sobrepeso e obesidade. Foi observada tendência significativa de redução do consumo regular de feijão segundo ano de realização da pesquisa, exceto para a categoria de idade entre os 45 e 54 anos. Ocorreu redução significativa da frequência do consumo do feijão pela população brasileira e a adoção de políticas de monitoramento e incentivo do consumo é necessária em função dos benefícios apresentados pela leguminosa. The scope of this paper was to analyze the trends of frequency of consumption of beans between the years 2006 and 2009 in the Brazilian capitals. This is a historical series using the Vigitel database for all Brazilian state capitals. Consumption of beans was described in terms of relative frequency and the trend was assessed using Poisson regression. Between 65.79% (2009) and 71.85% (2006) of participants reported consuming beans five or more days per week. The capitals Goiania, Belo Horizonte, Palmas, Brasilia and Cuiaba were in the highest frequency range of consumption throughout the study period. Individuals with a BMI in the appropriate and low weight category had the highest frequencies of consumption in comparison with the overweight and the obese. A significant reduction trend in the consumption of beans per year of the research, except for the 45 to 54-year-old range, was detected. The conclusion drawn was that there has been a significant reduction in the consumption of beans in the Brazilian population and the adoption of monitoring and incentive policies is necessary due to the benefits of the legume.

OBJETIVO: descrever os principais fatores de risco e proteção para doenças crônicas com dados do inquérito telefônico de 2010. METODOLOGIA: entrevistas telefônicas realizadas em amostra probabilística dos adultos residentes nas capitais do Brasil e Distrito Federal com telefone fixo residencial. As prevalências foram estratificadas por sexo, idade e escolaridade. RESULTADOS: Foi verificado alto consumo de refrigerantes (28%), de carne com gordura (46%) e de consumo abusivo de álcool (18%), e baixo consumo de frutas e hortaliças (18%) e de atividade física no lazer (15%). Aproximadamente metade da população referiu ter excesso de peso e não se proteger da radiação solar. A inatividade física e o tabagismo atingem cerca de 15% dos adultos. Fatores de risco foram mais prevalentes em homens, adultos jovens e de menor escolaridade. CONCLUSÃO: os resultados apontam diferentes comportamentos em saúde da população segundo características sociodemográficas. Essa variabilidade deve ser considerada nas ações de promoção de saúde. PURPOSE: To describe protection from chronic diseases and the prevalence of risk factors with data from a telephone survey in 2010. METHODS: Telephone interviews in a random sample of adults living in Brazilian state capitals and the Federal District with residential landline telephones. The prevalence of these factors was stratified by sex, age and level of education. RESULTS: High prevalence of soft drink consumption (28.1%), fatty meat consumption (34.2%), and alcohol abuse (18%) and low fruit and vegetable intake (18%) and leisure time physical activity (15%) was verified. Approximately half the population was overweight and reported no sun protection practices. Physical inactivity and smoking afflicted almost 15% of adults. In general, risk factors were more prevalent in men, predominantly young adults with lower education levels. CONCLUSION: The results revealed differing health behavior according to socio-demographic variables. These variables should be taken into consideration in health promotion campaigns.

The aim of this study was to analyze trends in indicators of smoking in Brazilian State capitals, according to the Surveillance System for Risk and Protective Factors for Chronic Illnesses Using a Telephone Survey (VIGITEL) in adults, from 2006 to 2011. A simple linear regression model was used (a = 5%). There was a decrease in the prevalence of smokers and heavy smokers among men and in individuals 35 to 54 years of age. Smoking also decreased among individuals with 9-11 years of schooling and in the Northeast, North, and Central West regions. For heavy smokers, the largest decline was in the Northeast. Brazil's regulatory policy has been responsible for the decline in tobacco prevalence.

To describe protection from chronic diseases and the prevalence of risk factors with data from a telephone survey in 2010.Telephone interviews in a random sample of adults living in Brazilian state capitals and the Federal District with residential landline telephones. The prevalence of these factors was stratified by sex, age and level of education.High prevalence of soft drink consumption (28.1%), fatty meat consumption (34.2%), and alcohol abuse (18%) and low fruit and vegetable intake (18%) and leisure time physical activity (15%) was verified. Approximately half the population was overweight and reported no sun protection practices. Physical inactivity and smoking afflicted almost 15% of adults. In general, risk factors were more prevalent in men, predominantly young adults with lower education levels.The results revealed differing health behavior according to socio-demographic variables. These variables should be taken into consideration in health promotion campaigns.

Pretendeu-se descrever o padrão de utilização, acesso e tipo de serviço odontológico utilizado por adultos e idosos das capitais brasileiras segundo características sociodemográficas. Foram utilizados dados do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL) de 2009 (n = 54.367). Mais da metade da população revelou necessitar de tratamento odontológico no último ano e desta, 15,2% não conseguiram atendimento. O uso de serviço odontológico privado foi de 61,1%. A participação do Sistema Único de Saúde variou de 6,2% no Distrito Federal a 35,2% em Boa Vista. Análises multivariáveis de Poisson revelaram que as maiores prevalências de percepção de necessidades de tratamento ocorreram nas mulheres, nos adultos de meia idade e nos mais escolarizados. Falta de acesso aos serviços odontológicos foram mais prevalentes em mulheres, nos mais jovens, nos menos escolarizados e nos pardos. Os resultados deste estudo revelam a existência de marcantes iniquidades na utilização e acesso de serviços odontológicos nas capitais brasileiras. This study aimed to evaluate access to and utilization of various types of dental services by individuals 18 years or older in Brazil's State capitals. We gathered data from the Telephone Survey Surveillance System for Risk and Protective Factors for Chronic Diseases (VIGITEL) in 2009 (n = 54,367). More than half of the target population reported the need for dental treatment in the previous year; of these, 15.2% lacked access to dental services when needed. The private sector provided 61.1% of all dental appointments. The share of services provided by the Unified National Health System (SUS) ranged from 6.2% in the Federal District to 35.2% in Boa Vista, in the North. Multivariate Poisson regression models showed higher prevalence of dental treatment needs among women, middle-aged adults, and individuals with more schooling. Lack of access to dental care was more frequent among women, young adults, less educated individuals, and among lightener-skinned blacks. Our findings highlight sharp inequalities in the use of and access to dental services in the Brazilian State capitals.

This study aimed to identify the association between alcohol and drug consumption and bullying on the one hand and involvement in situations of physical violence among adolescents 13 to 15 years in public and private schools in State capitals and the Federal District of Brazil. The study analyzed data from the National School Health Survey (PeNSE) for the year 2009. Data analysis used logistic regression. Prevalence of involvement in physical violence was 12.9% more common in boys than girls. Both genders showed associations between physical violence or being a victim of bullying and use of illegal drugs, plus the heightened effect of the combined consumption of alcohol and other drugs. In boys, alcohol consumption showed a significant association with physical violence. Having the father or both parents living at home was inversely associated with physical violence in girls. Knowledge of factors associated with physical violence among adolescents is important for supporting health promotion strategies and a culture of peace, thereby counteracting the idea of taking teenage violence for granted.

The scope of this paper was to analyze the trends of frequency of consumption of beans between the years 2006 and 2009 in the Brazilian capitals. This is a historical series using the Vigitel database for all Brazilian state capitals. Consumption of beans was described in terms of relative frequency and the trend was assessed using Poisson regression. Between 65.79% (2009) and 71.85% (2006) of participants reported consuming beans five or more days per week. The capitals Goiania, Belo Horizonte, Palmas, Brasilia and Cuiaba were in the highest frequency range of consumption throughout the study period. Individuals with a BMI in the appropriate and low weight category had the highest frequencies of consumption in comparison with the overweight and the obese. A significant reduction trend in the consumption of beans per year of the research, except for the 45 to 54-year-old range, was detected. The conclusion drawn was that there has been a significant reduction in the consumption of beans in the Brazilian population and the adoption of monitoring and incentive policies is necessary due to the benefits of the legume.

In order to estimate the prevalence of influenza like illness (ILI) in adults from all state capitals and geographic regions in Brazil, a periodical monitoring of ILI cases by the national telephone survey (VIGITEL) was carried out in 2010.A cross-sectional study with 47,876 telephone interviews in the state capitals and Federal District, a probabilistic sample of adult population (18 years-old) with landline telephone. Questions concerning the results of ILI cases and pandemic influenza (H1N1) 2009, from January 10 to November 30, were analyzed. The proportion of cases stratified by sociodemographic characteristics and Brazilian geographic region was weighted with data from the National Survey with Household Sampling (PNAD) 2008.The prevalence of ILI cases in the last 30 days before interview was 31.2% (95%CI 30.2-32.2%) for all state capitals and the Federal District. This prevalence was higher among women, young adults (18 to 29 years-old) and individuals with 9 to 11 years of schooling. According to the geographic region analysis, Northern Brazil presented the highest prevalence of ILI cases. A tendency to increase with further decrease was observed among the geographic regions, except the Northeast. Need for health care assistance was reported by 26.8% (95%CI 25.1-28.5) from ILI cases. Among ILI cases that sought health care assistance, 2.6% (95%CI 1.8-3.4) reported pandemic influenza (H1N1) 2009 medical suspicion.The results of this survey supported influenza surveillance as it provided timeliness and useful surveillance information, which were not captured by the traditional surveillance system, as the occurrence of ILI and need of health care assistance.

OBJETIVOS: Com o objetivo de estimar a prevalência da síndrome gripal em adultos das capitais e regiões do Brasil, realizou-se monitoramento da ocorrência de sinais e sintomas compatíveis por inquérito telefônico (VIGITEL) em 2010. MÉTODO: Estudo transversal que contou com 47.876 entrevistas nas capitais dos estados brasileiros e no Distrito Federal, com amostragem probabilística da população >18 anos, residente em domicílios com linha fixa de telefone. Foram analisadas as questões referentes à síndrome gripal e influenza pandêmica (H1N1) 2009, no período de 10 de janeiro a 30 de novembro de 2010. Os percentuais foram calculados para as regiões do país e para o Brasil e ponderados segundo a distribuição sociodemográfica da PNAD 2008. RESULTADOS: A prevalência de indivíduos, com algum sinal ou sintoma de gripe nos 30 dias anteriores à entrevista, foi de 31,2% (IC95% 30,2-32,2%). O relato de síndrome gripal foi mais frequente entre as mulheres, adultos jovens (18 a 29 anos) e aquelas pessoas com 9 a 11 anos de estudo. A maior prevalência de sinais ou sintomas gripais ocorreu na região Norte. Verificou-se tendência crescente com posterior decréscimo em todas as regiões, exceto na Nordeste. A procura pelo serviço de saúde foi relatada por 26,8% (IC95% 25,1-28,5) das pessoas que adoeceram. A suspeita médica de influenza pandêmica (H1N1) 2009 ocorreu em 2,6% (IC95% 1,8-3,4) dos entrevistados que relataram ter procurado o serviço de saúde. CONCLUSÃO: Os resultados deste inquérito forneceram informações oportunas e úteis, as quais não foram captadas pelo sistema de vigilância tradicional, como a ocorrência de sinal ou sintoma gripal e a procura pelo serviço de saúde. OBJECTIVES: In order to estimate the prevalence of influenza like illness (ILI) in adults from all state capitals and geographic regions in Brazil, a periodical monitoring of ILI cases by the national telephone survey (VIGITEL) was carried out in 2010. METHOD: A cross-sectional study with 47,876 telephone interviews in the state capitals and Federal District, a probabilistic sample of adult population (>18 years-old) with landline telephone. Questions concerning the results of ILI cases and pandemic influenza (H1N1) 2009, from January 10 to November 30, were analyzed. The proportion of cases stratified by sociodemographic characteristics and Brazilian geographic region was weighted with data from the National Survey with Household Sampling (PNAD) 2008. RESULTS: The prevalence of ILI cases in the last 30 days before interview was 31.2% (95%CI 30.2-32.2%) for all state capitals and the Federal District. This prevalence was higher among women, young adults (18 to 29 years-old) and individuals with 9 to 11 years of schooling. According to the geographic region analysis, Northern Brazil presented the highest prevalence of ILI cases. A tendency to increase with further decrease was observed among the geographic regions, except the Northeast. Need for health care assistance was reported by 26.8% (95%CI 25.1-28.5) from ILI cases. Among ILI cases that sought health care assistance, 2.6% (95%CI 1.8-3.4) reported pandemic influenza (H1N1) 2009 medical suspicion. CONCLUSION: The results of this survey supported influenza surveillance as it provided timeliness and useful surveillance information, which were not captured by the traditional surveillance system, as the occurrence of ILI and need of health care assistance.

This study aimed to evaluate access to and utilization of various types of dental services by individuals 18 years or older in Brazil's State capitals. We gathered data from the Telephone Survey Surveillance System for Risk and Protective Factors for Chronic Diseases (VIGITEL) in 2009 (n = 54,367). More than half of the target population reported the need for dental treatment in the previous year; of these, 15.2% lacked access to dental services when needed. The private sector provided 61.1% of all dental appointments. The share of services provided by the Unified National Health System (SUS) ranged from 6.2% in the Federal District to 35.2% in Boa Vista, in the North. Multivariate Poisson regression models showed higher prevalence of dental treatment needs among women, middle-aged adults, and individuals with more schooling. Lack of access to dental care was more frequent among women, young adults, less educated individuals, and among lightener-skinned blacks. Our findings highlight sharp inequalities in the use of and access to dental services in the Brazilian State capitals.

The identification of individuals with respiratory symptoms (RS) is important for the early detection of tuberculosis. The aim of this study was to estimate the prevalence of RS in three administrative regions of the Federal District, Brazil. For this, we used the 30 by 7 cluster sampling technique proposed by the World Health Organization. Individuals with RS were defined as those aged 15 years or older living in the administrative regions of Estrutural, Itapoã, or Varjão and reporting a cough lasting at least 3 weeks at the date of the interview. The prevalence of RS was 5.7% in Estrutural and Varjão (95% CI: 2.4-9.0) and 4.8% in Itapoã (95%CI: 1.6-7.9), with a design effect close to 1.0. In Estrutural and Itapoã, fewer years of schooling, and in Itapoã and Varjão, lower income, were associated with RS. Cigarette smoking was associated with the presence of RS in all regions. The prevalence of RS in the three administrative regions investigated is consistent with that of other areas with a similar socioeconomic profile.

OBJETIVO: Analisar e comparar o conhecimento sobre nutrição de professores e alunos do Projeto "a escola promovendo hábitos alimentares saudáveis", submetidos a duas estratégias de educação nutricional em escolas do Distrito Federal. MÉTODOS: O Projeto Escola utilizou duas estratégias de intervenção em educação nutricional: intervenção nutricional (A) ações educativas realizadas na comunidade escolar pela equipe; e intervenção nutricional (B) ações educativas desenvolvidas por professores que frequentaram oficinas de capacitação. O conhecimento das crianças foi avaliado por meio de um instrumento sobre pirâmide dos alimentos e um sobre higiene pessoal; sendo aplicado com os professores um questionário do tipo verdadeiro ou falso. RESULTADOS: Foram avaliadas 4 escolas com intervenção A (180 alunos e 19 professores) e 4 com intervenção B (129 alunos e 16 professores). A média de acertos no instrumento de pirâmide dos alimentos foi de 3,2 e 2,9 (p=0,37), respectivamente pelas crianças que receberam as intervenções nutricionais A e B. Na atividade sobre higiene pessoal, para estes mesmos alunos, observaram-se percentuais de acerto de 61,1% e 73,6% (p=0,10). Os professores que receberam as intervenções nutricionais A e B obtiveram percentuais de acertos semelhantes nos questionários, em torno de 90,0% (p=0,06). CONCLUSÃO: Observou-se que os dois tipos de intervenção de educação nutricional foram igualmente úteis para promover o conhecimento de alunos e professores. Portanto, faz-se necessário incentivar a realização de processos de educação nutricional no ambiente escolar, de acordo com a diretriz da Política Nacional de Alimentação e Nutrição que diz respeito à promoção da saúde. OBJECTIVE: The objective of this study was to analyze and compare the nutrition knowledge of teachers and students who participated in the study "Promotion of healthy eating habits by schools" and were submitted to two different strategies of nutrition education in schools of the Federal District, Brazil. METHODS: The study administered two strategies of nutrition education intervention: nutrition intervention (A) administration of educational activities in the school community by the research team; and nutrition intervention (B) educational activities were administered by teachers who participated in the training workshops..The knowledge of the students was assessed by an instrument based on the food pyramid and another one based on personal hygiene. The teachers were assessed by means of a true-or-false questionnaire. RESULTS: Four schools submitted to nutrition intervention A (180 students and 19 teachers) and four schools submitted to nutrition intervention B (129 students and 16 teachers) were assessed. The average number of correct answers given by the students on the instrument based on the food pyramid was 3.2 for students in intervention A and 2.9 for students in intervention B (p=0.37). On the instrument about personal hygiene for the same students, 61.1% and 73.6%, respectively, answered it correctly (p=0.10). The teachers submitted to interventions A and B answered a similar number of questions correctly, around 90.0% (p=0.06). CONCLUSION: This study showed that two different types of nutrition education intervention were equally useful to promote nutrition knowledge among teachers and students. Therefore, it is necessary to promote nutrition education programs in schools, in accordance with the National Food and Nutrition Policies, which regard health promotion strategies.

Foi analisado o conteúdo de ácidos graxos (AG) de 12 marcas de margarinas à base de óleos vegetais parcialmente hidrogenados ou interesterificados comercializados no Distrito Federal. As margarinas foram agrupadas pelo tipo de óleos utilizados em sua produção e o percentual médio de lipídios em GH-T (margarinas hidrogenadas com 50% de lipídios), GH-L (hidrogenadas com 20%), GI-T (interesterificadas com 65%) e GI-L (interesterificadas com 30%). O perfil de AG foi obtido por cromatografia gasosa em coluna capilar SP2560®. O conteúdo de AG trans (AGT) no GH-T (7,91 ± 1,05 g.100 g–1) foi significativamente maior (p < 0,05) que no GH-L (2,46 ± 0,39 g.100 g–1), GI-T (1,29 ± 0,47 g.100 g–1) e GI-L (0,65 ± 0,24 g.100 g–1). Houve diferença significativa no conteúdo total de AG saturados (AGS) e insaturados (AGI) entre os grupos GH-T e GI-T, sendo maior no GI-T, seguido de GH-T e sem diferença significativa entre GH-L e GI-L. Porém, as razões entre ΣAGP/ΣAGS das margarinas não variou entre os grupos, enquanto as razões entre ΣAGP/ΣAGT nas margarinas GI-T e GI-L foram superiores às demais. Os resultados obtidos indicam que as margarinas GI-T e GI-L seriam mais apropriadas para consumo humano, por possuírem menos AGT e uma melhor razão AGP/AGT que as demais. ______________________________________________________________________________________________________________ ABSTRACT The content of fatty acids (FA) of 12 margarine brands produced with partially hydrogenated or interesterified vegetable oils marketed in Federal District was analyzed. The margarines were grouped into four groups by the type of oils used in their production and by the average percentage of lipids: GH-T (hydrogenated margarines with 50% lipids), GH-L (hydrogenated with 20%), GI-T (interesterified with 65%) and GI-L (interesterified with 30%). The fatty acid profile was obtained by gas chromatography in a SP2560® capillary column. The content of trans fatty acids (TFA) in GH-T (7.91 ± 1.05 g.100 g–1) was significantly higher (p < 0.05) than in GH-L (2.46 ± 0.39 g.100 g–1), GI-T (1.29 ± 0.47 g.100 g–1) and GI-L (0.65 ± 0.24 g.100 g–1). There was a significant difference in the total content of saturated fatty acids (SFA) and in the unsaturated fatty acids (UFA) among the groups GH-T and GI-T, being higher in GI-T, followed by GH-T and with no significant difference between GH-L and GI-L. The ΣPUFA/ΣSFA ratios of the margarines were unchanged among the groups, while the ΣPUFA/ΣTFA ratios in the GI-T and GI-L groups were higher than in the others. The results suggest that GI-L and GI-T margarines would be more appropriate for human intake due to lower content of TFA and higher PUFA/TFA ratio than the others.

O objetivo deste estudo foi identificar a associação entre o consumo de álcool e outras drogas e o bullying com o envolvimento em situações de violência física entre adolescentes de 13 a 15 anos, em escolas públicas e privadas das capitais brasileiras e do Distrito Federal. Foram analisados os dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) de 2009. Para análise dos dados foi utilizada a regressão logística. A prevalência de envolvimento em situações de violência física foi 12,9% maior no sexo masculino. Em ambos os sexos, foram observadas associações entre violência física e ser vítima de bullying com o uso de drogas ilícitas e efeito potencializado do consumo de álcool e drogas. Para o sexo masculino, o uso de álcool mostrou associação significante com violência física. Morar o pai ou ambos os genitores na residência apresentou associação inversa para violência física no sexo feminino. O conhecimento de fatores associados à violência física entre adolescentes é importante para auxiliar estratégias de promoção da saúde e da cultura de paz, rompendo com a ideia de que a violência entre adolescentes é algo banal e esperado. This study aimed to identify the association between alcohol and drug consumption and bullying on the one hand and involvement in situations of physical violence among adolescents 13 to 15 years in public and private schools in State capitals and the Federal District of Brazil. The study analyzed data from the National School Health Survey (PeNSE) for the year 2009. Data analysis used logistic regression. Prevalence of involvement in physical violence was 12.9% more common in boys than girls. Both genders showed associations between physical violence or being a victim of bullying and use of illegal drugs, plus the heightened effect of the combined consumption of alcohol and other drugs. In boys, alcohol consumption showed a significant association with physical violence. Having the father or both parents living at home was inversely associated with physical violence in girls. Knowledge of factors associated with physical violence among adolescents is important for supporting health promotion strategies and a culture of peace, thereby counteracting the idea of taking teenage violence for granted.