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IntroduçãoO estudos têm sistematicamente demonstrado que saúde mental é crucial para o bem-estar geral dos indivíduos, sociedades e países. Os transtornos mentais representam algo em torno de 13% da sobrecarga de doenças no mundo. Apesar dessas constatações, a lacuna entre oferta e demanda de assistência em saúde mental é robusta, com estimativas de até 70% para transtornos de humor e 90% para transtornos por uso de álcool em países desenvolvidos. Os dados para países em desenvolvimento são escassos 1 .Um dos principais fatores para essa lacuna é o subdiagnóstico de transtornos mentais. De 25% a 50% dos pacientes que procuram assistên-cia médica em centros de atendimento primário têm pelo menos um transtorno psiquiátrico ou neurológico. Destes, a não detecção dos casos pode ser de 55% para diagnóstico de depressão e até 77% para transtorno de ansiedade generalizada 1 .Entre as estratégias para modificação desse contexto está a utilização de instrumentos de rastreamento psiquiátrico, que preferencialmente devem ser de fácil aplicação e baixo custo. Essas características são de grande relevância para seu emprego em larga escala na prática clínica e nos estudos de epidemiologia psiquiátrica 2 .Na

BackgroundHepatitis C chronic liver disease is a major cause of liver transplant in developed countries. This article reports the first nationwide population-based survey conducted to estimate the seroprevalence of HCV antibodies and associated risk factors in the urban population of Brazil.MethodsThe cross sectional study was conducted in all Brazilian macro-regions from 2005 to 2009, as a stratified multistage cluster sample of 19,503 inhabitants aged between 10 and 69 years, representing individuals living in all 26 State capitals and the Federal District. Hepatitis C antibodies were detected by a third-generation enzyme immunoassay. Seropositive individuals were retested by Polymerase Chain Reaction and genotyped. Adjusted prevalence was estimated by macro-regions. Potential risk factors associated with HCV infection were assessed by calculating the crude and adjusted odds ratios, 95% confidence intervals (95% CI) and p values. Population attributable risk was estimated for multiple factors using a case–control approach.ResultsThe overall weighted prevalence of hepatitis C antibodies was 1.38% (95% CI: 1.12%–1.64%). Prevalence of infection increased in older groups but was similar for both sexes. The multivariate model showed the following to be predictors of HCV infection: age, injected drug use (OR = 6.65), sniffed drug use (OR = 2.59), hospitalization (OR = 1.90), groups socially deprived by the lack of sewage disposal (OR = 2.53), and injection with glass syringe (OR = 1.52, with a borderline p value). The genotypes 1 (subtypes 1a, 1b), 2b and 3a were identified. The estimated population attributable risk for the ensemble of risk factors was 40%. Approximately 1.3 million individuals would be expected to be anti-HCV-positive in the country.ConclusionsThe large estimated absolute numbers of infected individuals reveals the burden of the disease in the near future, giving rise to costs for the health care system and society at large. The known risk factors explain less than 50% of the infected cases, limiting the prevention strategies. Our findings regarding risk behaviors associated with HCV infection showed that there is still room for improving strategies for reducing transmission among drug users and nosocomial infection, as well as a need for specific prevention and control strategies targeting individuals living in poverty.

Dietary prevention of allergic diseases in infants and small children. Part III: Critical review of published peer-reviewed observational and interventional studies and final recommendations.

Health strategies based on primary health care have been expanding in Brazil. An instrument applied to users, the Primary Care Assessment Tool (the PCATool), which measures the extent of primary care, has been validated in the United States. We sought to adapt the PCATool to Brazil and analyze its validation and reliability through a cross-sectional validation study of the Child PCATool. Validation included: translation, back-translation, adaptation, debriefing, content and construct validate, internal consistency, and reliability analysis. The questionnaire was applied to 468 parents or guardians of children registered with 18 primary health services in Porto Alegre, representing the services' normal pediatric population. Using factor analysis, 8 domains were identified, with Cronbach's aranging from 0.74 to 0.88. Validation resulted in a 45-item scale, divided into 8 attributes (Access to First Contact, Continuity, Coordination, 3 attributes of Comprehensiveness, Community Orientation, and Family Orientation). These results showed that the PCATool-Brasil has adequate validity and reliability and could be used as a national instrument to evaluate primary health care after its application to other population settings in the country.