Revista de Saúde Públicahttps://scielosp.org/feed/rsp/2014.v48n3/2017-01-30T00:05:00ZVol. 48 No. 3 - 2014WerkzeugScreening for depressive symptoms in older adults in the Family Health Strategy, Porto Alegre, Brazil10.1590/S0034-8910.20140480046602017-01-30T00:05:00Z2017-01-30T00:05:00ZNogueira, Eduardo LopesRubin, Leonardo LibrelottoGiacobbo, Sara de SouzaGomes, IrenioCataldo Neto, Alfredo
<em>Nogueira, Eduardo Lopes</em>;
<em>Rubin, Leonardo Librelotto</em>;
<em>Giacobbo, Sara De Souza</em>;
<em>Gomes, Irenio</em>;
<em>Cataldo Neto, Alfredo</em>;
<br/><br/>
OBJECTIVE To analyze the prevalence of depression in older adults and associated factors. METHODS Cross-sectional study using a stratified random sample of 621 individuals aged ≥ 60 from 27 family health teams in Porto Alegre, RS, Southern Brazil, between 2010 and 2012. Community health agents measured depression using the 15-item Geriatric Depression Scale. Scores of ≥ 6 were considered as depression and between 11 and 15 as severe depression. Poisson regression was used to search for independent associations of sociodemographic and self-perceived health with both depression and its severity. RESULTS The prevalence of depression was 30.6% and was significantly higher in women (35.9% women versus 20.9% men, p < 0.001). The variables independently associated with depression were: female gender (PR = 1.4, 95%CI 1.1;1.8); low education, especially illiteracy (PR = 1.8, 95%CI 1.2;2 6); regular self-rated health (OR = 2.2, 95%CI 1.6;3.0); and poor/very poor self-rated health (PR = 4.0, 95%CI 2.9;5.5). Except for education, the strength of association of these factors increases significantly in severe depression. CONCLUSIONS A high prevalence of depression was observed in the evaluations conducted by community health agents, professionals who are not highly specialized. The findings identified using the 15-item Geriatric Depression Scale in this way are similar to those in the literature, with depression more associated with low education, female gender and worse self-rated health. From a primary health care strategic point of view, the findings become still more relevant, indicating that community health agents could play an important role in identifying depression in older adults.Disability in instrumental activities of daily living among older adults: gender differences10.1590/S0034-8910.20140480047542017-01-30T00:05:00Z2017-01-30T00:05:00ZAlexandre, Tiago da SilvaCorona, Ligiana PiresNunes, Daniella PiresSantos, Jair Lício FerreiraDuarte, Yeda Aparecida de OliveiraLebrão, Maria Lúcia
<em>Alexandre, Tiago Da Silva</em>;
<em>Corona, Ligiana Pires</em>;
<em>Nunes, Daniella Pires</em>;
<em>Santos, Jair Lício Ferreira</em>;
<em>Duarte, Yeda Aparecida De Oliveira</em>;
<em>Lebrão, Maria Lúcia</em>;
<br/><br/>
OBJECTIVE To analyze gender differences in the incidence and determinants of disability regarding instrumental activities of daily living among older adults. METHODS The data were extracted from the Saúde, Bem-Estar e Envelhecimento (SABE – Health, Wellbeing and Ageing) study. In 2000, 1,034 older adults without difficulty in regarding instrumental activities of daily living were selected. The following characteristics were evaluated at the baseline: sociodemographic and behavioral variables, health status, falls, fractures, hospitalizations, depressive symptoms, cognition, strength, mobility, balance and perception of vision and hearing. Instrumental activities of daily living such as shopping and managing own money and medication, using transportation and using the telephone were reassessed in 2006, with incident cases of disability considered as the outcome. RESULTS The incidence density of disability in instrumental activities of daily living was 44.7/1,000 person/years for women and 25.2/1,000 person/years for men. The incidence rate ratio between women and men was 1.77 (95%CI 1.75;1.80). After controlling for socioeconomic status and clinical conditions, the incidence rate ratio was 1.81 (95%CI 1.77;1.84), demonstrating that women with chronic disease and greater social vulnerability have a greater incidence density of disability in instrumental activities of daily living. The following were determinants of the incidence of disability: age ≥ 80 and worse perception of hearing in both genders; stroke in men; and being aged 70 to 79 in women. Better cognitive performance was a protective factor in both genders and better balance was a protective factor in women. CONCLUSIONS The higher incidence density of disability in older women remained even after controlling for adverse social and clinical conditions. In addition to age, poorer cognitive performance and conditions that adversely affect communication disable both genders. Acute events, such as a stroke, disables elderly men more, whereas early deficits regarding balance disable women more.Cut-off point for WHOQOL-bref as a measure of quality of life of older adults10.1590/S0034-8910.20140480049122017-01-30T00:05:00Z2017-01-30T00:05:00ZSilva, Patrícia Aparecida BarbosaSoares, Sônia MariaSantos, Joseph Fabiano GuimarãesSilva, Líliam Barbosa
<em>Silva, Patrícia Aparecida Barbosa</em>;
<em>Soares, Sônia Maria</em>;
<em>Santos, Joseph Fabiano Guimarães</em>;
<em>Silva, Líliam Barbosa</em>;
<br/><br/>
OBJECTIVE To propose a cut-off for the World Health Organization Quality of Life-Bref (WHOQOL-bref) as a predictor of quality of life in older adults. METHODS Cross-sectional study with 391 older adults registered in the Northwest Health District in Belo Horizonte, MG, Southeastern Brazil, between October 8, 2010 and May 23, 2011. The older adults’ quality of life was measured using the WHOQOL-bref. The analysis was rationalized by outlining two extreme and simultaneous groups according to perceived quality of life and satisfaction with health (quality of life good/satisfactory – good or very good self-reported quality of life and being satisfied or very satisfied with health – G5; and poor/very poor quality of life – poor or very poor self-reported quality of life and feeling dissatisfied or very dissatisfied with health – G6). A Receiver-Operating Characteristic curve (ROC) was created to assess the diagnostic ability of different cut-off points of the WHOQOL-bref. RESULTS ROC curve analysis indicated a critical value 60 as the optimal cut-off point for assessing perceived quality of life and satisfaction with health. The area under the curve was 0.758, with a sensitivity of 76.8% and specificity of 63.8% for a cut-off of ≥ 60 for overall quality of life (G5) and sensitivity 95.0% and specificity of 54.4% for a cut-off of < 60 for overall quality of life (G6). CONCLUSIONS Diagnostic interpretation of the ROC curve revealed that cut-off < 60 for overall quality of life obtained excellent sensitivity and negative predictive value for tracking older adults with probable worse quality of life and dissatisfied with health.Social protection systems in vulnerable families: their importance for the public health10.1590/S0034-8910.20140480051312017-01-30T00:05:00Z2017-01-30T00:05:00ZArcos, EstelaSanchez, XimenaToffoletto, Maria CeciliaBaeza, MargaritaGazmuri, PatriciaMuñoz, Luz AngélicaVollrath, Antonia
<em>Arcos, Estela</em>;
<em>Sanchez, Ximena</em>;
<em>Toffoletto, Maria Cecilia</em>;
<em>Baeza, Margarita</em>;
<em>Gazmuri, Patricia</em>;
<em>Muñoz, Luz Angélica</em>;
<em>Vollrath, Antonia</em>;
<br/><br/>
OBJECTIVE To analyze the effectiveness of the Chilean System of Childhood Welfare in transferring benefits to socially vulnerable families. METHODS A cross-sectional study with a sample of 132 families from the Metropolitan Region, Chile, stratified according to degree of social vulnerability, between September 2011 and January 2012. Semi-structured interviews were conducted with mothers of the studied families in public health facilities or their households. The variables studied were family structure, psychosocial risk in the family context and integrated benefits from the welfare system in families that fulfill the necessary requirements for transfer of benefits. Descriptive statistics to measure location and dispersion were calculated. A binary logistic regression, which accounts for the sample size of the study, was carried out. RESULTS The groups were homogenous regarding family size, the presence of biological father in the household, the number of relatives living in the same dwelling, income generation capacity and the rate of dependency and psychosocial risk (p ≥ 0.05). The transfer of benefits was low in all three groups of the sample (≤ 23.0%). The benefit with the best coverage in the system was the Single Family Subsidy, whose transfer was associated with the size of the family, the presence of relatives in the dwelling, the absence of the father in the household, a high rate of dependency and a high income generation capacity (p ≤ 0.10). CONCLUSIONS The effectiveness of benefit transfer was poor, especially in families that were extremely socially vulnerable. Further explanatory studies of benefit transfers to the vulnerable population, of differing intensity and duration, are required in order to reduce health disparities and inequalities.Perceived health in the Portuguese population aged ? 3510.1590/S0034-8910.20140480052422017-01-30T00:05:00Z2017-01-30T00:05:00ZFigueiredo, João Paulo deCardoso, Salvador Massano
<em>Figueiredo, João Paulo De</em>;
<em>Cardoso, Salvador Massano</em>;
<br/><br/>
OBJECTIVE To evaluate the exploratory relationship between determinants of health, life satisfaction, locus of control, attitudes and behaviors and health related quality of life in an adult population. METHODS Observational study (analytical and cross-sectional) with a quantitative methodological basis. The sample was composed oy 1,214 inhabitants aged ≥ 35 in 31 civil parishes in the County of Coimbra, Portugal, 2011-2012. An anonymous and voluntary health survey was conducted, which collected the following information: demographic, clinical record, health and lifestyle behaviors; health related quality of life (Medical Outcomes Study, Short Form-36); health locus of control; survey of health attitudes and behavior, and quality of life index. Pearson’s Linear Correlation, t-Student, Wilcoxon-Mann-Whitney; One-way ANOVA; Brown-Forsythe’s F; Kruskal-Wallis; Multiple Comparisons: Tukey (HSD), Games-Howell and Conover were used in the statistical analysis. RESULTS Health related quality of life was shown to be lower in females, in older age groups, in obese/overweight individuals, widows, unassisted, those living alone, living in rural/suburban areas, those who did not work and with a medium-low socioeconomic level. Respondents with poor/very poor self-perceived health (p < 0.0001), with chronic disease (p < 0.0001), who consumed < 3 meals per day (p ≤ 0.01), who were sedentary, who slept ≤ 6 h/day and had smoked for several years revealed the worst health results. Health related quality of life was positively related with a bigger internal locus, with better health attitudes and behaviors (physical exercise, health and nutritional care, length of dependence) and with different areas of life satisfaction. CONCLUSIONS Better health related quality of life was associated with certain social, psychological, family and health characteristics, a satisfactory lifestyle, better socioeconomic conditions and a good internal locus of control over health attitudes and behaviors.HIV risk practices by female sex workers according to workplace10.1590/S0034-8910.20140480049922017-01-30T00:05:00Z2017-01-30T00:05:00ZDamacena, Giseli NogueiraSzwarcwald, Célia LandmannSouza Júnior, Paulo Roberto Borges de
<em>Damacena, Giseli Nogueira</em>;
<em>Szwarcwald, Célia Landmann</em>;
<em>Souza Júnior, Paulo Roberto Borges De</em>;
<br/><br/>
OBJECTIVE To investigate differences in HIV infection- related risk practices by Female Sex Workers according to workplace and the effects of homophily on estimating HIV prevalence. METHODS Data from 2,523 women, recruited using Respondent-Driven Sampling, were used for the study carried out in 10 Brazilian cities in 2008-2009. The study included female sex workers aged 18 and over. The questionnaire was completed by the subjects and included questions on characteristics of professional activity, sexual practices, use of drugs, HIV testing, and access to health services. HIV quick tests were conducted. The participants were classified in two groups according to place of work: on the street or indoor venues, like nightclubs and saunas. To compare variable distributions by place of work, we used Chi-square homogeneity tests, taking into consideration unequal selection probabilities as well as the structure of dependence between observations. We tested the effect of homophily by workplace on estimated HIV prevalence. RESULTS The highest HIV risk practices were associated with: working on the streets, lower socioeconomic status, low regular smear test coverage, higher levels of crack use and higher levels of syphilis serological scars as well as higher prevalence of HIV infection. The effect of homophily was higher among sex workers in indoor venues. However, it did not affect the estimated prevalence of HIV, even after using a post-stratification by workplace procedure. CONCLUSIONS The findings suggest that strategies should focus on extending access to, and utilization of, health services. Prevention policies should be specifically aimed at street workers. Regarding the application of Respondent-Driven Sampling, the sample should be sufficient to estimate transition probabilities, as the network develops more quickly among sex workers in indoor venues.Senses of body image in adolescents in elementary school10.1590/S0034-8910.20140480050832017-01-30T00:05:00Z2017-01-30T00:05:00ZSilva, Maria Lídia de AbreuTaquette, Stella ReginaCoutinho, Evandro Silva Freire
<em>Silva, Maria Lídia De Abreu</em>;
<em>Taquette, Stella Regina</em>;
<em>Coutinho, Evandro Silva Freire</em>;
<br/><br/>
OBJECTIVE To comprehend the perception of body image in adolescence. METHODS A qualitative study was conducted with eight focus groups with 96 students of both sexes attending four public elementary school institutions in the city of Rio de Janeiro, Southeastern Brazil, in 2013. An interview guide with questions about the adolescents’ feelings in relation to: their bodies, standards of idealized beauty, practice of physical exercise and sociocultural influences on self-image. In the data analysis we sought to understand and interpret the meanings and contradictions of narratives, understanding the subjects’ context and reasons and the internal logic of the group. RESULTS Three thematic categories were identified. The influence of media on body image showed the difficulty of achieving the perfect body and is viewed with suspicion in face of standards of beauty broadcast; the importance of a healthy body was observed as standards of beauty and good looks were closely linked to good physical condition and result from having a healthy body; the relationship between the standard of beauty and prejudice, as people who are not considered attractive, having small physical imperfections, are discriminated against and can be rejected or even excluded from society. CONCLUSIONS The standard of perfect body propagated by media influences adolescents’ self-image and, consequently, self-esteem and is considered an unattainable goal, corresponding to a standard of beauty described as artificial and unreal. However, it causes great suffering and discrimination against those who do not feel they are attractive, which can lead to health problems resulting from low self-esteem.Cumulative mortality of Aedes aegypti larvae treated with compounds10.1590/S0034-8910.20140480050222017-01-30T00:05:00Z2017-01-30T00:05:00ZTorres, Sandra MariaCruz, Nadine Louise Nicolau daRolim, Vitor Pereira de MatosCavalcanti, Maria Inês de AssisAlves, Leucio CâmaraSilva Júnior, Valdemiro Amaro da
<em>Torres, Sandra Maria</em>;
<em>Cruz, Nadine Louise Nicolau Da</em>;
<em>Rolim, Vitor Pereira De Matos</em>;
<em>Cavalcanti, Maria Inês De Assis</em>;
<em>Alves, Leucio Câmara</em>;
<em>Silva Júnior, Valdemiro Amaro Da</em>;
<br/><br/>
OBJECTIVE To evaluate the larvicidal activity of Azadirachta indica, Melaleuca alternifolia, carapa guianensis essential oils and fermented extract of Carica papaya against Aedes aegypti (Linnaeus, 1762) (Diptera: Culicidae). METHODS The larvicide test was performed in triplicate with 300 larvae for each experimental group using the third larval stage, which were exposed for 24h. The groups were: positive control with industrial larvicide (BTI) in concentrations of 0.37 ppm (PC1) and 0.06 ppm (PC2); treated with compounds of essential oils and fermented extract, 50.0% concentration (G1); treated with compounds of essential oils and fermented extract, 25.0% concentration (G2); treated with compounds of essential oils and fermented extract, 12.5% concentration (G3); and negative control group using water (NC1) and using dimethyl (NC2). The larvae were monitored every 60 min using direct visualization. RESULTS No mortality occurred in experimental groups NC1 and NC2 in the 24h exposure period, whereas there was 100% mortality in the PC1 and PC2 groups compared to NC1 and NC2. Mortality rates of 65.0%, 50.0% and 78.0% were observed in the groups G1, G2 and G3 respectively, compared with NC1 and NC2. CONCLUSIONS The association between three essential oils from Azadirachta indica, Melaleuca alternifolia, Carapa guianensis and fermented extract of Carica papaya was efficient at all concentrations. Therefore, it can be used in Aedes aegypti Liverpool third larvae stage control programs.Principal components and generalized linear modeling in the correlation between hospital admissions and air pollution10.1590/S0034-8910.20140480050782017-01-30T00:05:00Z2017-01-30T00:05:00ZSouza, Juliana Bottoni deReisen, Valdério AnselmoSantos, Jane MériFranco, Glaura Conceição
<em>Souza, Juliana Bottoni De</em>;
<em>Reisen, Valdério Anselmo</em>;
<em>Santos, Jane Méri</em>;
<em>Franco, Glaura Conceição</em>;
<br/><br/>
OBJECTIVE To analyze the association between concentrations of air pollutants and admissions for respiratory causes in children. METHODS Ecological time series study. Daily figures for hospital admissions of children aged < 6, and daily concentrations of air pollutants (PM10, SO2, NO2, O3 and CO) were analyzed in the Região da Grande Vitória, ES, Southeastern Brazil, from January 2005 to December 2010. For statistical analysis, two techniques were combined: Poisson regression with generalized additive models and principal model component analysis. Those analysis techniques complemented each other and provided more significant estimates in the estimation of relative risk. The models were adjusted for temporal trend, seasonality, day of the week, meteorological factors and autocorrelation. In the final adjustment of the model, it was necessary to include models of the Autoregressive Moving Average Models (p, q) type in the residuals in order to eliminate the autocorrelation structures present in the components. RESULTS For every 10:49 μg/m3 increase (interquartile range) in levels of the pollutant PM10 there was a 3.0% increase in the relative risk estimated using the generalized additive model analysis of main components-seasonal autoregressive – while in the usual generalized additive model, the estimate was 2.0%. CONCLUSIONS Compared to the usual generalized additive model, in general, the proposed aspect of generalized additive model − principal component analysis, showed better results in estimating relative risk and quality of fit.Disparities in cervical and breast cancer mortality in Brazil10.1590/S0034-8910.20140480052142017-01-30T00:05:00Z2017-01-30T00:05:00ZGirianelli, Vania ReisGamarra, Carmen JustinaAzevedo e Silva, Gulnar
<em>Girianelli, Vania Reis</em>;
<em>Gamarra, Carmen Justina</em>;
<em>Azevedo E Silva, Gulnar</em>;
<br/><br/>
OBJECTIVE To analyze cervical and breast cancer mortality in Brazil according to socioeconomic and welfare indicators. METHODS Data on breast and cervical cancer mortality covering a 30-year period (1980-2010) were analyzed. The data were obtained from the National Mortality Database, population data from the Brazilian Institute of Geography and Statistics database, and socioeconomic and welfare information from the Institute of Applied Economic Research. Moving averages were calculated, disaggregated by capital city and municipality. The annual percent change in mortality rates was estimated by segmented linear regression using the joinpoint method. Pearson’s correlation coefficients were conducted between average mortality rate at the end of the three-year period and selected indicators in the state capital and each Brazilian state. RESULTS There was a decline in cervical cancer mortality rates throughout the period studied, except in municipalities outside of the capitals in the North and Northeast. There was a decrease in breast cancer mortality in the capitals from the end of the 1990s onwards. Favorable socioeconomic indicators were inversely correlated with cervical cancer mortality. A strong direct correlation was found with favorable indicators and an inverse correlation with fertility rate and breast cancer mortality in inner cities. CONCLUSIONS There is an ongoing dynamic process of increased risk of cervical and breast cancer and attenuation of mortality because of increased, albeit unequal, access to and provision of screening, diagnosis and treatment. Spatial study of homicide rates in the state of Bahia, Brazil, 1996-201010.1590/S0034-8910.20140480052012017-01-30T00:05:00Z2017-01-30T00:05:00ZSouza, Tiago Oliveira dePinto, Liana WernersbachSouza, Edinilsa Ramos de
<em>Souza, Tiago Oliveira De</em>;
<em>Pinto, Liana Wernersbach</em>;
<em>Souza, Edinilsa Ramos De</em>;
<br/><br/>
OBJECTIVE To analyze the spatial distribution of homicide mortality in the state of Bahia, Northeastern Brazil. METHODS Ecological study of the 15 to 39-year old male population in the state of Bahia in the period 1996-2010. Data from the Mortality Information System, relating to homicide (X85-Y09) and population estimates from the Brazilian Institute of Geography and Statistics were used. The existence of spatial correlation, the presence of clusters and critical areas of the event studied were analyzed using Moran’s I Global and Local indices. RESULTS A non-random spatial pattern was observed in the distribution of rates, as was the presence of three clusters, the first in the north health district, the second in the eastern region, and the third cluster included townships in the south and the far south of Bahia. CONCLUSIONS The homicide mortality in the three different critical areas requires further studies that consider the socioeconomic, cultural and environmental characteristics in order to guide specific preventive and interventionist practices.Deported Mexican migrants: health status and access to care10.1590/S0034-8910.20140480051502017-01-30T00:05:00Z2017-01-30T00:05:00ZFernández-Niño, Julián AlfredoRamírez-Valdés, Carlos JacoboCerecero-Garcia, DiegoBojorquez-Chapela, Ietza
<em>Fernández-Niño, Julián Alfredo</em>;
<em>Ramírez-Valdés, Carlos Jacobo</em>;
<em>Cerecero-Garcia, Diego</em>;
<em>Bojorquez-Chapela, Ietza</em>;
<br/><br/>
OBJECTIVE To describe the health status and access to care of forced-return Mexican migrants deported through the Mexico-United States border and to compare it with the situation of voluntary-return migrants. METHODS Secondary data analysis from the Survey on Migration in Mexico’s Northern Border from 2012. This is a continuous survey, designed to describe migration flows between Mexico and the United States, with a mobile-population sampling design. We analyzed indicators of health and access to care among deported migrants, and compare them with voluntary-return migrants. Our analysis sample included 2,680 voluntary-return migrants, and 6,862 deportees. We employ an ordinal multiple logistic regression model, to compare the adjusted odds of having worst self-reported health between the studied groups. RESULTS As compared to voluntary-return migrants, deportees were less likely to have medical insurance in the United States (OR = 0.05; 95%CI 0.04;0.06). In the regression model a poorer self-perceived health was found to be associated with having been deported (OR = 1.71, 95%CI 1.52;1.92), as well as age (OR = 1.03, 95%CI 1.02;1.03) and years of education (OR = 0.94 95%CI 0.93;0.95). CONCLUSIONS According to our results, deportees had less access to care while in the United States, as compared with voluntary-return migrants. Our results also showed an independent and statistically significant association between deportation and having poorer self-perceived health. To promote the health and access to care of deported Mexican migrants coming back from the United States, new health and social policies are required.Cross-cultural validity of the demand-control questionnaire: Swedish and Brazilian workers10.1590/S0034-8910.20140480051262017-01-30T00:05:00Z2017-01-30T00:05:00ZHökerberg, Yara Hahr MarquesReichenheim, Michael EduardoFaerstein, EduardoPassos, Sonia Regina LambertFritzell, JohanToivanen, SusannaWesterlund, Hugo
<em>Hökerberg, Yara Hahr Marques</em>;
<em>Reichenheim, Michael Eduardo</em>;
<em>Faerstein, Eduardo</em>;
<em>Passos, Sonia Regina Lambert</em>;
<em>Fritzell, Johan</em>;
<em>Toivanen, Susanna</em>;
<em>Westerlund, Hugo</em>;
<br/><br/>
OBJECTIVE To evaluate the cross-cultural validity of the Demand-Control Questionnaire, comparing the original Swedish questionnaire with the Brazilian version. METHODS We compared data from 362 Swedish and 399 Brazilian health workers. Confirmatory and exploratory factor analyses were performed to test structural validity, using the robust weighted least squares mean and variance-adjusted (WLSMV) estimator. Construct validity, using hypotheses testing, was evaluated through the inspection of the mean score distribution of the scale dimensions according to sociodemographic and social support at work variables. RESULTS The confirmatory and exploratory factor analyses supported the instrument in three dimensions (for Swedish and Brazilians): psychological demands, skill discretion and decision authority. The best-fit model was achieved by including an error correlation between work fast and work intensely (psychological demands) and removing the item repetitive work (skill discretion). Hypotheses testing showed that workers with university degree had higher scores on skill discretion and decision authority and those with high levels of Social Support at Work had lower scores on psychological demands and higher scores on decision authority. CONCLUSIONS The results supported the equivalent dimensional structures across the two culturally different work contexts. Skill discretion and decision authority formed two distinct dimensions and the item repetitive work should be removed.Tuberculosis Control Program and patient satisfaction, Rio de Janeiro, Brazil10.1590/S0034-8910.20140480047932017-01-30T00:05:00Z2017-01-30T00:05:00ZPortela, Margareth CrisóstomoLima, Sheyla Maria LemosBrito, CláudiaFerreira, Vanja Maria BessaEscosteguy, Claudia CaminhaVasconcellos, Maurício Teixeira Leite de
<em>Portela, Margareth Crisóstomo</em>;
<em>Lima, Sheyla Maria Lemos</em>;
<em>Brito, Cláudia</em>;
<em>Ferreira, Vanja Maria Bessa</em>;
<em>Escosteguy, Claudia Caminha</em>;
<em>Vasconcellos, Maurício Teixeira Leite De</em>;
<br/><br/>
OBJECTIVE To evaluate factors associated with users’ satisfaction in the Tuberculosis Control Program. METHODS A cross-sectional study of 295 patients aged ≥ 18 years, with two or more outpatient visits in the Tuberculosis Control Program, in five cities in the metropolitan region of Rio de Janeiro, RJ, Southeastern Brazil, in 2010. Considering an estimated population of 4,345 patients, the sampling plan included 15 health care units participating in the program, divided into two strata: units in Rio de Janeiro City, selected with probability proportional to the monthly average number of outpatient visits, and units in the other four cities. In the units, four temporal clusters of five patients each were selected with equal probability, totaling 300 patients. A questionnaire investigating the users’ clinical and sociodemographic variables and aspects of care and service in the program relevant to user satisfaction was applied to the patients. Descriptive statistics about users and their satisfaction with the program were obtained, and the effects of factors associated with satisfaction were estimated. RESULTS Patients were predominantly males (57.7%), with a mean age of 40.9 and with low level of schooling. The mean treatment time was 4.1 months, mostly self-administered (70.4%). Additionally, 25.8% had previously been treated for tuberculosis. There was a high level of satisfaction, especially regarding medication provision, and respect to patients by the health professionals. Patients who were younger (≤ 30), those on self-administered treatment, and with graduate level, showed less satisfaction. Suggestions to improve the services include having more doctors (70.0%), and offering exams in the same place of attendance (55.1%). CONCLUSIONS Patient satisfaction with the Tuberculosis Control Program was generally high, although lower among younger patients, those with university education and those on self-administered treatment. The study indicates the need for changes to structural and organizational aspects of care, and provides practical support for its improvement.Temporal trends and spatial distribution of unsafe abortion in Brazil, 1996-201210.1590/S0034-8910.20140480048782017-01-30T00:05:00Z2017-01-30T00:05:00ZMartins-Melo, Francisco RogerlândioLima, Mauricélia da SilveiraAlencar, Carlos HenriqueRamos Jr, Alberto NovaesCarvalho, Francisco Herlânio CostaMachado, Márcia Maria TavaresHeukelbach, Jorg
<em>Martins-Melo, Francisco Rogerlândio</em>;
<em>Lima, Mauricélia Da Silveira</em>;
<em>Alencar, Carlos Henrique</em>;
<em>Ramos Jr, Alberto Novaes</em>;
<em>Carvalho, Francisco Herlânio Costa</em>;
<em>Machado, Márcia Maria Tavares</em>;
<em>Heukelbach, Jorg</em>;
<br/><br/>
OBJECTIVE To analyze temporal trends and distribution patterns of unsafe abortion in Brazil. METHODS Ecological study based on records of hospital admissions of women due to abortion in Brazil between 1996 and 2012, obtained from the Hospital Information System of the Ministry of Health. We estimated the number of unsafe abortions stratified by place of residence, using indirect estimate techniques. The following indicators were calculated: ratio of unsafe abortions/100 live births and rate of unsafe abortion/1,000 women of childbearing age. We analyzed temporal trends through polynomial regression and spatial distribution using municipalities as the unit of analysis. RESULTS In the study period, a total of 4,007,327 hospital admissions due to abortions were recorded in Brazil. We estimated a total of 16,905,911 unsafe abortions in the country, with an annual mean of 994,465 abortions (mean unsafe abortion rate: 17.0 abortions/1,000 women of childbearing age; ratio of unsafe abortions: 33.2/100 live births). Unsafe abortion presented a declining trend at national level (R2: 94.0%, p < 0.001), with unequal patterns between regions. There was a significant reduction of unsafe abortion in the Northeast (R2: 93.0%, p < 0.001), Southeast (R2: 92.0%, p < 0.001) and Central-West regions (R2: 64.0%, p < 0.001), whereas the North (R2: 39.0%, p = 0.030) presented an increase, and the South (R2: 22.0%, p = 0.340) remained stable. Spatial analysis identified the presence of clusters of municipalities with high values for unsafe abortion, located mainly in states of the North, Northeast and Southeast Regions. CONCLUSIONS Unsafe abortion remains a public health problem in Brazil, with marked regional differences, mainly concentrated in the socioeconomically disadvantaged regions of the country. Qualification of attention to women’s health, especially to reproductive aspects and attention to pre- and post-abortion processes, are necessary and urgent strategies to be implemented in the country.Non-adherence to telemedicine interventions for drug users: systematic review10.1590/S0034-8910.20140480051302017-01-30T00:05:00Z2017-01-30T00:05:00ZMoreira, Taís de CamposSignor, LucianaFigueiró, Luciana RizzieriFernandes, SimoneBortolon, Cassandra BorgesBenchaya, Mariana CanellasFerigolo, MaristelaBarros, Helena MT
<em>Moreira, Taís De Campos</em>;
<em>Signor, Luciana</em>;
<em>Figueiró, Luciana Rizzieri</em>;
<em>Fernandes, Simone</em>;
<em>Bortolon, Cassandra Borges</em>;
<em>Benchaya, Mariana Canellas</em>;
<em>Ferigolo, Maristela</em>;
<em>Barros, Helena Mt</em>;
<br/><br/>
OBJECTIVE To estimate rates of non-adherence to telemedicine strategies aimed at treating drug addiction. METHODS A systematic review was conducted of randomized controlled trials investigating different telemedicine treatment methods for drug addiction. The following databases were consulted between May 18, 2012 and June 21, 2012: PubMed, PsycINFO, SciELO, Wiley (The Cochrane Library), Embase, Clinical trials and Google Scholar. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the quality of the studies. The criteria evaluated were: appropriate sequence of data generation, allocation concealment, blinding, description of losses and exclusions and analysis by intention to treat. There were 274 studies selected, of which 20 were analyzed. RESULTS Non-adherence rates varied between 15.0% and 70.0%. The interventions evaluated were of at least three months duration and, although they all used telemedicine as support, treatment methods differed. Regarding the quality of the studies, the values also varied from very poor to high quality. High quality studies showed better adherence rates, as did those using more than one technique of intervention and a limited treatment time. Mono-user studies showed better adherence rates than poly-user studies. CONCLUSIONS Rates of non-adherence to treatment involving telemedicine on the part of users of psycho-active substances differed considerably, depending on the country, the intervention method, follow-up time and substances used. Using more than one technique of intervention, short duration of treatment and the type of substance used by patients appear to facilitate adherence.Interface between Intellectual Disability and Mental Health: hermeneutic review10.1590/S0034-8910.20140480047112017-01-30T00:05:00Z2017-01-30T00:05:00ZSurjus, Luciana Togni de Lima e SilvaCampos, Rosana Teresa Onocko
<em>Surjus, Luciana Togni De Lima E Silva</em>;
<em>Campos, Rosana Teresa Onocko</em>;
<br/><br/>
A literature review was conducted aiming to understand the interface between the Intellectual Disability and Mental Health fields and to contribute to mitigating the path of institutionalizing individuals with intellectual deficiencies. The so-called dual diagnosis phenomenon remains underestimated in Brazil but is the object of research and specific public policy internationally. This phenomenon alerts us to the prevalence of mental health problems in those with intellectual disabilities, limiting their social inclusion. The findings reinforce the importance of this theme and indicate possible diagnostic invisibility of the development of mental illness in those with intellectual disabilities in Brazil, which may contribute to sustaining psychiatric institutionalization of this population. Phytotherapy in primary health care10.1590/S0102-311X20070006000212017-01-30T00:05:00Z2017-01-30T00:05:00ZAntonio, Gisele DamianTesser, Charles DalcanaleMoretti-Pires, Rodrigo Otavio
<em>Antonio, Gisele Damian</em>;
<em>Tesser, Charles Dalcanale</em>;
<em>Moretti-Pires, Rodrigo Otavio</em>;
<br/><br/>
OBJECTIVE To characterize the integration of phytotherapy in primary health care in Brazil. METHODS Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed. RESULTS Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions. CONCLUSIONS Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population.