Revista de Saúde Públicahttps://scielosp.org/feed/rsp/2019.v53/2017-01-30T00:05:00ZUnknown authorVol. 53 - 2019WerkzeugScoping review of studies on food marketing in Latin America: Summary of existing evidence and research gaps10.11606/s1518-8787.20190530011842017-01-30T00:05:00Z2017-01-30T00:05:00ZChemas-Velez, Maria ManuelaGómez, Luis F.Velasquez, AlcidesMora-Plazas, MercedesParra, Diana C.
<em>Chemas-Velez, Maria Manuela</em>;
<em>Gómez, Luis F.</em>;
<em>Velasquez, Alcides</em>;
<em>Mora-Plazas, Mercedes</em>;
<em>Parra, Diana C.</em>;
<br/><br/>
ABSTRACT OBJECTIVE To document the evidence about marketing of ultra-processed foods and “non-alcoholic” beverages in Latin America. METHODS We performed a structured search of quantitative and qualitative studies in PubMed, SciELO and LILACS, published between January 2000 and May 2017 and conducted in Latin America. We conducted a quality assessment following a standardized tool and a thematic analysis to identify key typologies of marketing across studies RESULTS Out of 521 studies screened by title and abstract, we included 36 in this review; 27 of them analyzed television advertisement. Other marketing channels studied were food packaging, point of sale and outdoor advertisement. Studies found television advertises foods and beverages that are mostly ultraprocessed foods and have low nutritional value, particularly those promoted during children’s programming. We also observed children have a literal interpretation of images printed on food packaging, so this can be deceiving. Several studies also found proximity to unhealthy foods may increase their consumption. Finally, the thematic analysis identified the following typologies of food marketing: a) television advertisement, b) food packaging marketing, c) marketing strategies at points of sale and d) other marketing strategies. We found almost no advertisements for unprocessed or minimally processed foods such as fruits and vegetables. We did not find any studies on digital marketing conducted in the region. CONCLUSIONS This review found that the main channel of food marketing was television advertising. This synthesis provides insights to the challenges unhealthy eating represents to the public health of Latin America and identifies knowledge gaps to guide future research.The role of food processing in the inflammatory potential of diet during pregnancy10.11606/s1518-8787.20190530011542017-01-30T00:05:00Z2017-01-30T00:05:00ZSilva, Carolina AssisSantos, Izabela da SilvaShivappa, NitinHebert, James R.Crivellenti, Lívia CastroSartorelli, Daniela Saes
<em>Silva, Carolina Assis</em>;
<em>Santos, Izabela Da Silva</em>;
<em>Shivappa, Nitin</em>;
<em>Hebert, James R.</em>;
<em>Crivellenti, Lívia Castro</em>;
<em>Sartorelli, Daniela Saes</em>;
<br/><br/>
ABSTRACT The aim was to investigate the relationship between the energy contribution (E%) of foods according to the degree of industrial processing and the energy-adjusted dietary inflammatory index (E-DII) in pregnancy. Two 24-hour dietary recalls were obtained from each of the 784 pregnant women. Adjusted linear regression models allowed observing an inverse association between E-DII scores and E% from minimally processed foods β = -0.049 (95%CI -0.055– -0.042) and a direct association with the E% of ultra-processed foods β = 0.052 (95%CI 0.045–0.058), indicating a relationship between the dietary inflammatory potential and the degree of industrial processing of foods.Erratum10.11606/s1518-8787.2019053001264err2017-01-30T00:05:00Z2017-01-30T00:05:00ZErratum10.11606/s1518-8787.2019053000909err2017-01-30T00:05:00Z2017-01-30T00:05:00ZSocial participation in the health technology incorporation process into Unified Health System10.11606/s1518-8787.20190530014202017-01-30T00:05:00Z2017-01-30T00:05:00ZSilva, Aline SilveiraSousa, Maria Sharmila Alina deSilva, Emília Vitória daGalato, Dayani
<em>Silva, Aline Silveira</em>;
<em>Sousa, Maria Sharmila Alina De</em>;
<em>Silva, Emília Vitória Da</em>;
<em>Galato, Dayani</em>;
<br/><br/>
ABSTRACT OBJECTIVE To describe the current process of social participation in the incorporation of health technologies in Brazil, within the context of the Unified Health System (SUS). METHODS A descriptive study was conducted based on the analysis of official records of the actions of the National Committee for Health Technology Incorporation into Unified Health System and its website, from the beginning of its activities in January 2012 until December 2017. RESULTS The findings indicate that, in Brazil, there are legal instruments related to social participation in health, including the health technology assessment (HTA) field. However, its implementation is relatively recent and has been carried out gradually. In addition to the legal instruments (National Health Council representative, public consultation and public hearing forecast), other information and transparency strategies have been shown to be allied to social participation in the incorporation of health technologies. However, activities such as legally provided public hearings have not yet been carried out. CONCLUSIONS Several actions to foster social participation were developed over the analyzed period, but they need to be evaluated in order to maintain or improve them. In addition, there is a need for more qualified social participation in the various existing spaces, including those prescribed by law.Association between social conditions and oral health in school failure10.11606/s1518-8787.20190530014572017-01-30T00:05:00Z2017-01-30T00:05:00ZCunha, Inara Pereira daPereira, Antonio CarlosMeneghim, Marcelo de CastroFrias, Antônio CarlosMialhe, Fábio Luiz
<em>Cunha, Inara Pereira Da</em>;
<em>Pereira, Antonio Carlos</em>;
<em>Meneghim, Marcelo De Castro</em>;
<em>Frias, Antônio Carlos</em>;
<em>Mialhe, Fábio Luiz</em>;
<br/><br/>
ABSTRACT OBJECTIVE To evaluate the association of school failure among Brazilian adolescents with social conditions and aspects of oral health through hierarchical analysis. METHODS A state-wide survey of 5,558 adolescents from the state of São Paulo, Brazil, inquired about the sociodemographic and social capital of participants by using a structured questionnaire. Trained and calibrated professionals performed intraoral examinations and interviews in the households. Questions about the access to dentist, reason for and frequency of using dental services, toothache episodes and impact of oral conditions on daily activities (OIDP) were applied. Oral examinations evaluated caries experience, tooth losses, periodontal problems, presence of open bite, and maxillary and mandibular overjet. School failure was estimated according to the teenagers’ years of schooling. The independent variables were grouped into three blocks: sociodemographic and economic characteristics, social capital and oral health aspects. The multiple hierarchical logistic regression model was used to identify the factors associated with school failure. RESULTS Of the total sample, information about schooling of 5,162 adolescents was obtained, of whom 29.6% presented school failure. We found that adolescents over the age of 16 years who did not declare themselves as white, female, with feelings of insecurity, unhappiness, with toothache, caries, tooth losses, affected by dentofacial and/or periodontal changes, were more likely to fail at school. CONCLUSION Oral disorders and social factors were associated with school failure in adolescents. A successful school trajectory was a strong determinant of health, therefore actions between the educational and health sectors must be developed for adolescents, especially those with this profile.Tooth loss in adults: factors associated with the position and number of lost teeth10.11606/s1518-8787.20190530013182017-01-30T00:05:00Z2017-01-30T00:05:00ZGomes Filho, Valmir VanderleiGondinho, Brunna Verna CastroSilva-Junior, Manoelito FerreiraCavalcante, Denise de Fátima BarrosBulgareli, Jaqueline VilelaSousa, Maria da Luz Rosario deFrias, Antonio CarlosBatista, Marília JesusPereira, Antonio Carlos
<em>Gomes Filho, Valmir Vanderlei</em>;
<em>Gondinho, Brunna Verna Castro</em>;
<em>Silva-Junior, Manoelito Ferreira</em>;
<em>Cavalcante, Denise De Fátima Barros</em>;
<em>Bulgareli, Jaqueline Vilela</em>;
<em>Sousa, Maria Da Luz Rosario De</em>;
<em>Frias, Antonio Carlos</em>;
<em>Batista, Marília Jesus</em>;
<em>Pereira, Antonio Carlos</em>;
<br/><br/>
ABSTRACT OBJECTIVE To evaluate the factors associated with tooth loss in adults from the position and number of teeth lost in the dental arches. METHODS This is a cross-sectional, population-based study with adults participating in the epidemiological survey of oral health of São Paulo in 2015. The outcome of the study was tooth loss, assessed by the proposed classification, namely: I) lost up to 12 back teeth; II) lost up to 12 teeth (including front teeth); and III) lost more than 12 teeth. A four-block analysis was conducted, supported by a conceptual theoretical model adapted for tooth loss. For the multinomial logistic regression, “individuals who did not lose teeth due to caries or periodontal disease” was used as reference (p < 0.05). RESULTS Of 6,051 adults evaluated, 25.3% (n = 1,530) were classified in category I, 32.7% (n = 1,977) in II, 9.4% (n = 568) in III, and 1.9% (n = 117) were edentulous. Lower income and schooling, the perception of need for treatment and the last appointment motivated by routine, pain or extraction were associated with tooth loss, regardless of the classification. The negative evaluation of the dental service was associated with individuals who lost up to 12 teeth, both front and back. The presence of women and periodontal pocket were associated with tooth loss of up to 12 teeth, including front, and more than 12 teeth. Caries were associated with adults who lost up to 12 teeth, including front teeth. CONCLUSION The proposed classification allowed the identification of differences between the associated factors. Thus, the need to consider such classification in future studies is evident.Influence of the Mais Médicos (More Doctors) Program on health services access and use in Northeast Brazil10.11606/s1518-8787.20190530015712017-01-30T00:05:00Z2017-01-30T00:05:00ZGonçalves, Rogério FabianoBezerra, Adriana Falangola BenjaminTanaka, Oswaldo Y.Santos, Carlos Renato dosSilva, Keila Silene de Brito eSousa, Islândia Maria Carvalho de
<em>Gonçalves, Rogério Fabiano</em>;
<em>Bezerra, Adriana Falangola Benjamin</em>;
<em>Tanaka, Oswaldo Y.</em>;
<em>Santos, Carlos Renato Dos</em>;
<em>Silva, Keila Silene De Brito E</em>;
<em>Sousa, Islândia Maria Carvalho De</em>;
<br/><br/>
ABSTRACT OBJECTIVE To evaluate the influence of the Mais Médicos (More Doctors) Program on the performance of primary health care by quantifying health services access and use in Northeast Brazil, based on the population size of the municipalities, on the financial investment in health, and on the number of physicians in the family health teams. METHOD Evaluative research of quantitative nature. Access was evaluated by the population coverage ratio of the Family Health Strategy and use of health services, which were measured by medical appointments conducted between April 2013 and September 2015. We defined processes for database selection, adjustment, and validation, including explanatory variables for a sample of 896 municipalities. The analysis was based on the time periods before and after the implementation of the program. The Wilcoxon signed-rank test and non-parametric alternatives constituted statistical tests in the comparative analysis of the data. RESULTS A 19.2% increase was observed in the number of medical appointments between the first six months and the final six months of the data series. In this period, the median appointments in municipalities with up to 5,000 inhabitants increased from 701.0 to 768.0; while in those with more than 100,000 inhabitants it decreased from 285.5 to 280.0 (p < 0.05). Between April 2013 and September 2015, the median coverage ratio of the family health teams increased from 89.2% to 95.3%, approaching 100% in the municipalities with up to 20,000 inhabitants. CONCLUSIONS The study highlights the expansion of access and use of primary health care services in the northeast region after the implementation of the Mais Médicos (More Doctors) Program. Between April 2013 and September 2015, the coverage of family health teams and the production of medical appointments increased, constituting important achievements for SUS.Adiposity, depression and anxiety: interrelationship and possible mediators10.11606/s1518-8787.20190530011192017-01-30T00:05:00Z2017-01-30T00:05:00ZGomes, Ana PaulaSoares, Ana Luiza G.Menezes, Ana M.B.Assunção, Maria CecíliaWehrmeister, Fernando C.Howe, Laura D.Gonçalves, Helen
<em>Gomes, Ana Paula</em>;
<em>Soares, Ana Luiza G.</em>;
<em>Menezes, Ana M.b.</em>;
<em>Assunção, Maria Cecília</em>;
<em>Wehrmeister, Fernando C.</em>;
<em>Howe, Laura D.</em>;
<em>Gonçalves, Helen</em>;
<br/><br/>
ABSTRACT OBJECTIVES To explore the association between adiposity, major depressive disorder and generalized anxiety disorder, and to assess the role of inflammation, diet quality and physical activity in this association. METHODS We used data from 2,977 individuals from the 1993 Pelotas Cohort (Brazil) who attended the 18- and 22-year follow-ups. We assessed general obesity using body mass index, fat mass index, and abdominal obesity using waist circumference. Major Depressive Disorder and generalized anxiety disorder were assessed using the mini-international neuropsychiatric interview. C-reactive protein and interleukin-6 (IL-6) levels were used as a measure of inflammation; diet quality was estimated using the revised diet quality index, and physical activity was assessed by the International physical activity questionnaire (IPAQ, min/day). The association between adiposity and major depressive disorder and generalized anxiety disorder was assessed using logistic regression, and the natural indirect effect via the mediators was estimated using G-computation. RESULTS General obesity assessed by body mass index (OR: 2.3; 95% CI:1.13; 4.85), fat mass index (OR: 2.6; 95%CI: 1.37; 4.83), and abdominal obesity (OR: 2.5; 95%CI: 1.18; 5.39) were associated with higher odds of major depressive disorder, whereas major depressive disorder was only associated with obesity assessed by body mass index (OR=1.9; 95% CI: 1.09; 3.46). Obesity and generalized anxiety disorder were not associated. C-reactive protein, diet quality and physical activity did not mediate the effect of obesity on major depressive disorder, and C-reactive protein mediated about 25% of the effect of major depressive disorder on adiposity. CONCLUSIONS Depression, but not generalized anxiety disorder, is associated with adiposity in both directions, with a stronger evidence for the direction obesity-depression. Inflammation explains part of the effect of major depressive disorder on obesity but not the other way around. Further research should explore other mechanisms that could be involved in the association between obesity and depression.How important is school environment in explaining individual variance of health behaviors?10.11606/s1518-8787.20190530015682017-01-30T00:05:00Z2017-01-30T00:05:00ZBoing, Antonio FernandoSubramanian, SVBoing, Alexandra Crispim
<em>Boing, Antonio Fernando</em>;
<em>Subramanian, Sv</em>;
<em>Boing, Alexandra Crispim</em>;
<br/><br/>
ABSTRACT We analyzed data from the National School-based Health Survey (PeNSE) carried out in Brazil in 2015 (n = 102,072 adolescents) to estimate how much of the individual variance in the prevalence of health behaviors is attributable to the school level. Multilevel logistic regression models were calculated to estimate the variance partitional coefficient (VPC) of the use of drugs, intake of unhealthy food, leisure physical activity and weight-related behaviors. The between-schools variance was significant in all tested models. The highest VPCs were observed when the use of drugs was analyzed (15%-20% of the total variance of smoking and use of illegal drugs). Lower, but still significant, values were observed in the other outcomes. The school context plays an important role in the adolescents’ health and should be considered in the design of public policies and actions in public health.Factors associated with fetal macrosomia10.11606/s1518-8787.20190530012692017-01-30T00:05:00Z2017-01-30T00:05:00ZAgudelo-Espitia, VanessaParra-Sosa, Beatriz ElenaRestrepo-Mesa, Sandra L
<em>Agudelo-Espitia, Vanessa</em>;
<em>Parra-Sosa, Beatriz Elena</em>;
<em>Restrepo-Mesa, Sandra L</em>;
<br/><br/>
ABSTRACT OBJECTIVE To evaluate the clinical factors, as well as weight gain, in a group of pregnant women, associating them with fetal macrosomia in a public institution in Antioquia, Colombia, from 2010-2017. METHODS A case-control study, using secondary information registries. Cases were defined using newborn weight of ≥ 4000g, while controls were defined as newborn weight between 3000–3999g. A proportion ratio (PR) was established to evaluate factors associated with macrosomia, and a generalized linear model (GLM) of Poisson regression with robust variance was used to evaluate the aspects that best explained macrosomia in the neonate. RESULTS 122 pregnant women participated in the study, of which 611 were cases and 61 were controls. Of the participants, 44.3% had pre-pregnancy overweight and 48.4% had excess gestational weight gain. Statistically significant differences were found between the groups in the following variables: pre-pregnancy BMI (p = 0.004), gestational weight gain (p = 0.000), gestational diabetes (p = 0.000), and type of delivery (p = 0.004). According to the regression model, a macrosomic newborn is 3.5 times more likely in women with excessive gestational weight gain (95%CI 1.78-7.18) and twice more likely in women who have gestational diabetes (95%CI 1.51-2.76). Of women with pre-pregnancy excess weight, 63% had excess gestational weight gain. CONCLUSIONS Within this cohort, pre-pregnancy BMI, excess weight gain in pregnancy, and the presence of gestational diabetes were associated with an increased risk of neonatal macrosomia. pre-pregnancy BMI and weight gain in pregnancy are modifiable risk factors that are responsive to nutrition interventions, which can minimize adverse perinatal outcomes.Effectiveness of the Mobile Emergency Medical Services (SAMU): use of interrupted time series10.11606/s1518-8787.20190530013962017-01-30T00:05:00Z2017-01-30T00:05:00ZOliveira, Cátia C. MartinsNovaes, Hillegonda Maria DutihAlencar, Airlane PereiraSantos, Itamar S.Damasceno, Maria Cecilia T.Souza, Heraldo Possolo de
<em>Oliveira, Cátia C. Martins</em>;
<em>Novaes, Hillegonda Maria Dutih</em>;
<em>Alencar, Airlane Pereira</em>;
<em>Santos, Itamar S.</em>;
<em>Damasceno, Maria Cecilia T.</em>;
<em>Souza, Heraldo Possolo De</em>;
<br/><br/>
ABSTRACT OBJECTIVE To evaluate the performance of the Mobile Emergency Medical Services (SAMU) in the ABC Region, using myocardial infarction as tracer condition. METHODS The analysis of interrupted time series was the approach chosen to test immediate and gradual effects of the intervention on the study population. The research comprised adjusted monthly time series of the hospital mortality rate by myocardial infarction in the period between 2000 and 2011. Data were extracted from the Mortality Information System (SIM), using segmented regression analysis to evaluate the level and trend of the intervention before and after its implementation. To strengthen the internal validity of the study, a control region was included. RESULTS The analysis of interrupted time series showed a reduction of 0.04 deaths per 100,000 inhabitants in the mortality rate compared to the underlying trend since the implementation of the Emergency Medical Services (p = 0.0040; 95%CI: −0.0816 – −0.0162) and a reduction in the level of 2.89 deaths per 100,000 inhabitants (p = 0.0001; 95%CI: −4.3293 – −1.4623), both with statistical significance. Regarding the control region, Baixada Santista, the difference in the result trend between intervention outcome and post-intervention control of −0.0639 deaths per 100,000 inhabitants was statistically significant (p = 0.0031; 95%CI: −0.1060 – −0.0219). We cannot exclude confounders, but we limited their presence in the study by including control region series. CONCLUSIONS Although the analysis of interrupted time series has limitations, this modeling can be useful for analyzing the performance of policies and programs. Even though the intervention studied is not a condition that in itself implies effectiveness, the latter would not be present without the former, which, integrated with other conditions, generates a positive result. SAMU is a strategy that must be expanded when formulating and consolidating policies focusing on emergency care.Interventions for the prevention of risk factors and incidence of type 2 diabetes in the work environment: a systematic review10.11606/s1518-8787.20190530010842017-01-30T00:05:00Z2017-01-30T00:05:00ZInolopú, JorgeHilario-Huapaya, NélidaTantaleán-Del-Águila, Martín AlonsoHurtado-Roca, YamileeUgarte-Gil, Cesar
<em>Inolopú, Jorge</em>;
<em>Hilario-Huapaya, Nélida</em>;
<em>Tantaleán-Del-Águila, Martín Alonso</em>;
<em>Hurtado-Roca, Yamilee</em>;
<em>Ugarte-Gil, Cesar</em>;
<br/><br/>
ABSTRACT OBJECTIVE To evaluate the effectiveness of interventions aimed at the prevention of risk factors and incidence of type 2 diabetes in the workers population. METHODS Systematic review of interventions aimed at adult workers at risk of type 2 diabetes published in Medline, Embase, Web of Science, Central Cochrane Registry of Controlled Trials, and Lilacs. Randomized trials, quasi-experimental research and cohort studies were selected; in English, Spanish and Portuguese; published from 2000 to 2017. Intervention effectiveness was evaluated concerning the incidence of type 2 diabetes and a significant reduction in body weight, or another anthropometric or metabolic parameter. RESULTS 3,024 articles were generated, of which 2,825 that did not answer the research question were eliminated, as well as 130 that did not evaluate original interventions, 57 carried out outside the workplace and two reviews; so that 10 selected items remained. Interventions based on structured programs previously evaluated and integrated into the workplace had a favorable impact on the reduction of body weight and other risk factors. CONCLUSIONS The effectiveness of lifestyle interventions for the prevention of type 2 diabetes should be based on structured programs with proven effectiveness and adapted to the workplace, with employer participation in the provision of schedules and work environments.Effect of the Melhor em Casa program on hospital costs10.11606/s1518-8787.20190530008592017-01-30T00:05:00Z2017-01-30T00:05:00ZNishimura, FábioCarrara, Aniela FagundesFreitas, Carlos Eduardo de
<em>Nishimura, Fábio</em>;
<em>Carrara, Aniela Fagundes</em>;
<em>Freitas, Carlos Eduardo De</em>;
<br/><br/>
ABSTRACT OBJECTIVE To verify if the Melhor em Casa program can actually reduce hospitalization costs. METHODS We use as an empirical strategy a Regression Discontinuity Design, which reduces endogeneity problems of our model. We also performed tests of heterogeneous responses and robustness. Data on the dependent variable, namely hospitalization costs, were collected in the Department of Informatics of the Unified Health System (DATASUS), using the microdata set from the Hospital Admissions System of the Unified Health System (SUS) from 2010 to 2013, totaling 3,609,384 observations. The covariates or control variables used were age and costs with patients in the intensive care unit, also from DATASUS. RESULTS The results point out that the Melhor em Casa program effectively reduced hospitalization costs by approximately 4.7% in 2011, 5.8% in 2012 and 10.2% in 2013. CONCLUSIONS Based on the analyses, we observed that maintaining the program can effectively improve the management of public resources, since it reduced the hospitalization costs in the three years studied. The program reduced hospitalization costs of risk groups and also in situations that usually increase hospital costs such as lack of equipment and elective hospitalizations. Thus, it can be affirmed that the program can reduce hospitalization costs, especially in risk and more vulnerable groups, showing efficiency as a public policy.Public open spaces and physical activity: disparities of resources in Florianópolis10.11606/s1518-8787.20190530011642017-01-30T00:05:00Z2017-01-30T00:05:00ZManta, Sofia WolkerReis, Rodrigo SiqueiraBenedetti, Tânia Rosane BertoldoRech, Cassiano Ricardo
<em>Manta, Sofia Wolker</em>;
<em>Reis, Rodrigo Siqueira</em>;
<em>Benedetti, Tânia Rosane Bertoldo</em>;
<em>Rech, Cassiano Ricardo</em>;
<br/><br/>
ABSTRACT OBJECTIVE: To analyze the association between sociodemographic characteristics of census tracts and the presence/quality of public open spaces and physical activity facilities. METHODS: A cross-sectional study was conducted in 643 census tracts in Florianópolis, Brazil, the presence and quality of public open spaces and physical activity facilities were objectively analyzed and the data by census tracts using Geographic Information Systems was treated. Outcomes were analyzed considering the census tracts as having: ≥ 1 public open spaces; ≥ 1 public open spaces with high quality; ≥ 2 physical activity facilities and high-quality physical activity facilities. Sociodemographic characteristics were the independent variables. Logistic regression analysis was performed. RESULTS: Census tracts with a medium-income (OR = 1.8; 95%CI 1.1–3.0) and high-income (OR = 2.4; 95%CI 1.4–4.0), in those with medium (OR = 1.7; 95%CI 1.0–2.7) and high residential density (OR = 2.0; 95%CI 1,2–3.3), and with higher proportions of older adults (OR = 3.3; 95%CI 1.9–5.7) had a higher proportion of public open spaces. Census tracts with higher proportions of children/adolescents (OR = 0.3; 95%CI 0.2–0.6) and non-white residents (OR= 0.6; 95%CI 0.3–0.9) were less likely to contain public open spaces. The tracts with medium (OR = 4.0; 95%CI 1.4–11.3) and high-income (OR = 3.6; 95%CI 1.2–10.2) were more likely to contain public open spaces with ≥ 2 structures for physical activity, compared with those with low-income. We observed the inverse in sectors with a high proportion of non-white residents (OR = 0.3; 95%CI 0.1–0.9). CONCLUSIONS: Census tracts with higher proportions of children or adolescents, non-white individuals and those in the low-income strata had lower odds of containing public open spaces and physical activity facilities.Differentiated thyroid carcinoma: a 5-years survival study at a referral hospital in Brazil10.11606/s1518-8787.20190530014962017-01-30T00:05:00Z2017-01-30T00:05:00ZBorges, Anne Karin da MotaFerreira, Jeniffer DantasKoifman, SergioKoifman, Rosalina Jorge
<em>Borges, Anne Karin Da Mota</em>;
<em>Ferreira, Jeniffer Dantas</em>;
<em>Koifman, Sergio</em>;
<em>Koifman, Rosalina Jorge</em>;
<br/><br/>
ABSTRACT BACKGROUND: Although the prognosis of differentiated thyroid carcinoma (DTC) therapy is considered excellent over time, some cases have a poorer prognosis and evolve into death. OBJECTIVE: This study aimed to estimate the 5-year specific survival and to identify prognosis factors in a cohort of DTC adult subjects. METHODS: Survival probability was estimated by Kaplan-Meier’s method in a retrospective hospital-based cohort study. Comparisons were made by log-rank test. Prognosis factors were identified using Cox risk modeling and crude and adjusted Hazard Ratio measures were obtained. Two models were estimated, considering age grouping of the 7th and 8th editions of TNM. RESULTS: Specific 5-year survival in the cohort was 98.5% (95%CI: 94.2 – 97.5). Considering TNM 7th edition, the risk estimates were 9.88 (95%CI: 1.67 – 58.33) for age group ≥ 55 years, 18.87 (95%CI: 7.38 – 48.29) for individuals with distant metastasis, 6.36 (95%CI: 2.26 – 17.91) for patients who underwent lymphadenectomy and 0.16 (95%CI: 0.06 – 0.43) for those who received radioiodine therapy. For TNM 8th edition, the risk estimates were 10.12 (95%CI: 2.05 – 50.09) for age group ≥ 55 years, 12.43 (95%CI: 4.58 – 33.77) for individuals with distant metastasis, 5.06 (95%CI: 1.82 – 14.05) for patients who underwent lymphadenectomy and 0.19 (95%CI: 0.07 – 0.51) for those who received radioiodine therapy. CONCLUSIONS: This cohort had a very high survival over a 5-year period. The prognosis was negatively influenced by age, distant metastasis and lymphadenectomy, whereas radioiodine therapy was found to be protective.Horizon scanning in Brazil: outputs and repercussions10.11606/s1518-8787.20190530014392017-01-30T00:05:00Z2017-01-30T00:05:00ZGomes, Pollyanna Teresa CiriloMata, Verónica ElizabethBorges, Thais ConceiçãoGalato, Dayani
<em>Gomes, Pollyanna Teresa Cirilo</em>;
<em>Mata, Verónica Elizabeth</em>;
<em>Borges, Thais Conceição</em>;
<em>Galato, Dayani</em>;
<br/><br/>
ABSTRACT OBJECTIVE: To describe the four types of horizon scanning (HS) outputs developed by the National Committee for Health Technology Incorporation (CONITEC) and show their main repercussions on the decision-making processes of the Brazilian Ministry of Health (MH). METHODS: Descriptive study based on participant observation and document analysis of HS outputs (internal reports, alert reports, briefs and sections for CONITEC recommendation reports) developed between January 2014 and July 2018. RESULTS: Fifteen internal reports, six alert reports, two briefs and 57 HS sections were produced. Each output has a specific structure according to its purpose. The methodological approach adopted for developing HS outputs in Brazil is described by EuroScan International Network. The outputs had institutional and international repercussions. The activities resulted in the inclusion of HS as a tool for reducing health lawsuits in the legal framework of the MH. One of the internal reports on a high-cost drug not approved in Brazil for a rare disease was requested by the Health Technology Assessments Network for the Americas (RedETSA), showing the international relevance of the outputs. The HS sections in recommendation reports influenced discussions about incorporating technologies into the Unified Health System. CONCLUSIONS: The developed outputs have purposes ranging from helping build arguments for defense of the MH in cases of health judicialization to inform decision-making processes. In addition, HS sections in recommendation reports have grown in importance recently. CONITEC’s HS system has been structured, and its role as a tool to inform health managers has shown to be been relevant.Developing a deprivation index to study geographical health inequalities in Ecuador10.11606/s1518-8787.20190530014102017-01-30T00:05:00Z2017-01-30T00:05:00ZPeralta, AndrésEspinel-Flores, VerónicaGotsens, MercèPérez, GlòriaBenach, JoanMarí-Dell’Olmo, Marc
<em>Peralta, Andrés</em>;
<em>Espinel-Flores, Verónica</em>;
<em>Gotsens, Mercè</em>;
<em>Pérez, Glòria</em>;
<em>Benach, Joan</em>;
<em>Marí-Dell’olmo, Marc</em>;
<br/><br/>
ABSTRACT OBJECTIVES: To develop a deprivation index to study health inequalities in 221 areas of Ecuador, to describe the pattern of deprivation in Ecuador, and to explore the applications of the index to study health inequalities by analysing the association between deprivation and mortality in the study areas. METHODS: We performed principal component analyses of available indicators of the 221 cantons of Ecuador. A set of 41 sociodemographic, social capital, and subjective well-being variables were obtained from the 2010 National Population Census and the National Living Conditions Survey 2013–2014. To explore the application of the index in public health, the association between the index and standardised mortality ratios was estimated through a Poisson regression model. RESULTS: The final index was constructed with 17 indicators. The first component explained 51.8% of the total variance of the data. A geographic pattern and a positive association of the index with the standardised mortality ratios of the cantons were observed in both men and women. CONCLUSIONS: We constructed a deprivation index that can identify disadvantaged areas in Ecuador. This index could be a valuable tool for the detection of vulnerabilised populations and the development of interventions and policies adapted to local needs.Evaluation of at-risk infant care: comparison between models of primary health care10.11606/s1518-8787.20190530010632017-01-30T00:05:00Z2017-01-30T00:05:00ZSamelli, Alessandra GiannellaTomazelli, Gislene AndradeAlmeida, Maria Helena Morgani deOliver, Fátima CorrêaRondon-Melo, SilmaraMolini-Avejonas, Daniela Regina
<em>Samelli, Alessandra Giannella</em>;
<em>Tomazelli, Gislene Andrade</em>;
<em>Almeida, Maria Helena Morgani De</em>;
<em>Oliver, Fátima Corrêa</em>;
<em>Rondon-Melo, Silmara</em>;
<em>Molini-Avejonas, Daniela Regina</em>;
<br/><br/>
ABSTRACT OBJECTIVES To analyze the health care network for at-risk infants in the western region of the city of São Paulo, with the primary health care as coordinator, and to compare the presence and extension of attributes of primary health care in the services provided, according to the service management model (Family Health Strategy and traditional basic health units). METHODS A survey was conducted with all at-risk infants born in the western region of São Paulo between 2013 and 2014. The children were then actively searched for a later application of the PCATool – child version. The total of 233 children were located in the territory; 113 guardians agreed to participate, and 81 composed the final sample. RESULTS Regarding the results of PCATool for overall and essential scores, the units with Family Health Strategy were better evaluated by users, when compared with traditional basic health units, showing a statistically significant difference. However, these scores were low for both management models. Regarding attributes, the Family Health Strategy presented better performance compared with traditional basic health units for most of them, except for coordination of information systems. Of ten assessed attributes, seven reached values ≥6.6 for Family Health Strategy and two for the traditional basic health unit. CONCLUSIONS Regardless of the type of management model, low overall and essential scores were found, indicating that guardians of at-risk infants rated some attributes as unsatisfactory, with emphasis on accessibility, integrality and family guidance. Such a performance may have negative consequences for the quality and integrality of these infants’ health care.Mental disorders and suicide risk in emerging adulthood: the 1993 Pelotas birth cohort10.11606/s1518-8787.201905300123562017-01-30T00:05:00Z2017-01-30T00:05:00ZGomes, Ana PaulaSoares, Ana Luiza G.Kieling, ChristianRohde, Luis AugustoGonçalves, Helen
<em>Gomes, Ana Paula</em>;
<em>Soares, Ana Luiza G.</em>;
<em>Kieling, Christian</em>;
<em>Rohde, Luis Augusto</em>;
<em>Gonçalves, Helen</em>;
<br/><br/>
ABSTRACT OBJECTIVE To assess the prevalence of some mental disorders and suicide risk, and the association between them in youths. METHODS Data from the 1993 Pelotas Birth Cohort (Brazil) was used. The prevalence of mental disorders at 22 years [major depressive disorder (MDD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), attention-deficit/ hyperactivity disorder (ADHD), bipolar disorders type 1 and 2 (BD1; BD2), post-traumatic stress disorder (PTSD), and antisocial personality disorder (APD)] and of suicide risk were assessed using the Mini International Neuropsychiatric Interview (n = 3,781). Comorbidity between disorders was also assessed. Association of each mental disorder and the number of disorders with suicide risk was assessed using Poisson regression. RESULTS The prevalence of any mental disorder was 19.1% (95%CI 17.8–20.3), and GAD was the most prevalent (10.4%; 95%CI 9.5–11.4). The prevalence of current suicide risk was 8.8% (95%CI 5.9–9.7). All disorders (except APD) and the suicide risk were higher among women. Mental disorders were associated with a higher suicide risk, with the highest risks being observed for MDD (RR = 5.6; 95%CI 4.1–7.8) and PTSD (RR = 5.0; 95%CI 3.9–6.3). The higher the number of co-occurring mental disorders, the higher the risk of suicide. CONCLUSIONS Our findings showed that about 20% of the youths had at least one mental disorder. However, this prevalence is underestimated since other relevant mental disorders were not assessed. Mental disorders were associated with higher suicide risk, especially the comorbidity between them.School environment and oral health promotion: the National Survey of School Health (PeNSE)10.11606/s1518-8787.20190530013762017-01-30T00:05:00Z2017-01-30T00:05:00ZNery, Newillames GonçalvesJordão, Lidia Moraes RibeiroFreire, Maria do Carmo Matias
<em>Nery, Newillames Gonçalves</em>;
<em>Jordão, Lidia Moraes Ribeiro</em>;
<em>Freire, Maria Do Carmo Matias</em>;
<br/><br/>
ABSTRACT OBJECTIVE To evaluate the potential support of schools for oral health promotion and associated factors in Brazilian capitals. METHODS Data from 1,339 public and private schools of the 27 Brazilian capitals were obtained from the National Survey of School Health (PeNSE) 2015. Data from the capitals were obtained from the United Nations Development Program and the Department of Informatics of the Brazilian Unified Health System (Datasus). The indicator “ ambiente escolar promotor de saúde bucal ” (AEPSB – oral health promoting school environment) was designed from 21 variables of the school environment with possible influence on students’ oral health employing the categorical principal components analysis (CATPCA). Associations between the AEPSB and characteristics of schools, capitals and regions were tested (bivariate analysis). RESULTS Ten variables comprised CAPTCA, after excluding those with low correlation or high multicollinearity. The analysis resulted in a model with three dimensions: D1. Within-school aspects (sales of food with added sugar in the canteen and health promotion actions), D2. Aspects of the area around the school (sales of food with added sugar in alternative points) and D3. prohibitive policies at school (prohibition of alcohol and tobacco consumption). The sum of the scores of the dimensions generated the AEPSB indicator, dichotomized by the median. From the total of schools studied, 51.2% (95%CI 48.5–53.8) presented a more favorable environment for oral health (higher AEPSB). In the capitals, this percentage ranged from 36.6% (95%CI 23.4–52.2) in Rio Branco to 80.4% (95%CI 67.2–89.1) in Florianópolis. Among the Brazilian regions, it ranged from 45.5% (95%CI 40.0–51.2) in the North to 67.6% (95%CI 59.4–74.9) in the South. Higher percentages of schools with higher AEPSB were found in public schools [58.1% (95%CI 54.9–61.2)] and in capitals and regions with higher Human Development Index [61.0% (95%IC 55.8–66.0) and 57.4% (95%CI 53.2–61.4), respectively] and lower Gini index [55.7% (95%CI 51.2–60.0) and 52.8 (95%CI 49.8–55.8), respectively]. CONCLUSIONS The potential to support oral health promotion in schools in Brazilian capitals, assessed by the AEPSB indicator, was associated with contextual factors of schools, capitals and Brazilian regions.Yellow fever: profile of cases and factors associated with death in a hospital in the State of Rio de Janeiro, 2017–201810.11606/s1518-8787.20190530014342017-01-30T00:05:00Z2017-01-30T00:05:00ZEscosteguy, Claudia CaminhaPereira, Alessandra Gonçalves LisbôaMarques, Marcio Renan Vinícius EspínolaLima, Tatiana Rodrigues de AraujoGalliez, Rafael MelloMedronho, Roberto de Andrade
<em>Escosteguy, Claudia Caminha</em>;
<em>Pereira, Alessandra Gonçalves Lisbôa</em>;
<em>Marques, Marcio Renan Vinícius Espínola</em>;
<em>Lima, Tatiana Rodrigues De Araujo</em>;
<em>Galliez, Rafael Mello</em>;
<em>Medronho, Roberto De Andrade</em>;
<br/><br/>
ABSTRACT OBJECTIVE Describe the clinical and epidemiological profile of confirmed cases of yellow fever whose patients were hospitalized in a general hospital for infectious diseases in the State of Rio de Janeiro, Brazil, from March 11, 2017 to June 15, 2018, during a recent outbreak and factors associated with death. METHODS This is a retrospective observational study with analysis of secondary databases of local epidemiological surveillance system, and complementary data collection from epidemiological investigation records and clinical records. Study variables included demographic, epidemiological, clinical, and laboratory data. A descriptive statistical analysis and a bivariate and multivariate analysis by logistic regression were performed to analyze factors associated with death. RESULTS Fifty-two patients diagnosed with yellow fever were hospitalized, 86.5% male patients, median age 49.5 years, 40.4% rural workers. The most frequent signs and symptoms were fever (90.4%), jaundice (86.5%), nausea and/or vomiting (69.2%), changes in renal excretion (53.8%), bleeding (50%), and abdominal pain (48.1%), with comorbidity in 38.5% of all cases. The lethality rate was 40.4%. Factors significantly associated with a higher chance of death in the bivariate analysis were: bleeding, changes in renal excretion, and maximum values of direct bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, and creatinine. In the multivariate analysis by logistic regression, only changes in renal excretion and ALT remained significant predictors of higher chance of death. A threshold effect was also observed for AST. The cutoff points identified as high risk for death were ALT > 4,000 U/L and AST > 6,000 U/L. CONCLUSIONS This study contributed to the knowledge on the profile of confirmed cases of high severity yellow fever. The main factors associated with death were changes in renal excretion and elevated serum transaminases, especially ALT. High lethality emphasizes the need for early diagnosis and treatment, and the importance of increasing vaccination coverage.Regulatory framework for dietary supplements and the public health challenge10.11606/s1518-8787.20190530012632017-01-30T00:05:00Z2017-01-30T00:05:00ZMolin, Thaís Ramos DalLeal, Gabriela CameraMüller, Larissa SaboMuratt, Diana TomazziMarcon, Gabriela ZanellaCarvalho, Leandro Machado deViana, Carine
<em>Molin, Thaís Ramos Dal</em>;
<em>Leal, Gabriela Camera</em>;
<em>Müller, Larissa Sabo</em>;
<em>Muratt, Diana Tomazzi</em>;
<em>Marcon, Gabriela Zanella</em>;
<em>Carvalho, Leandro Machado De</em>;
<em>Viana, Carine</em>;
<br/><br/>
ABSTRACT OBJECTIVE The new regulatory framework for dietary supplements in Brazil prompted this analysis of the current outlook of these products and the challenges posed by the new guidelines. METHODS We conducted a qualitative, observational and descriptive study of dietary supplements commercialized in Brazilian online stores with the help of the Google® search tool. We considered the ingredients on the labels, the effects attributed to these products and the commercial claims used as a means of promoting them to assess the necessary changes for the legal framework in the new guidelines. Finally, with the help of a database, we compared the effects declared by the manufacturers and attributed to certain ingredients with the scientific evidence described in literature. RESULTS In total, we purchased 44 dietary supplements from Brazilian online stores (n = 7). Of the samples studied, 34.2% could not be classified in the category Dietary Supplements, as recommended by the new regulation of the Brazilian Health Regulatory Agency due to the presence of prohibited substances; 16% of products should be commercialized as medicines. Regarding the commercial appeals, 97.7% had banned expressions. Numerous claims of effects attributed to certain products were characterized as consumer fraud because they have no scientific evidence. CONCLUSIONS The necessary changes represent a major regulatory and production challenge due to the wide range of dietary supplements and markets, an effort that aims to protect the consumers’ health. Some previous gaps in the regulatory framework were not fully solved.Prevalence and co-occurrence of modifiable risk factors in adults and older people10.11606/s1518-8787.20190530011422017-01-30T00:05:00Z2017-01-30T00:05:00ZFrancisco, Priscila Maria Stolses BergamoAssumpção, Daniela deBorim, Flávia Silva ArbexSenicato, CarolineMalta, Deborah Carvalho
<em>Francisco, Priscila Maria Stolses Bergamo</em>;
<em>Assumpção, Daniela De</em>;
<em>Borim, Flávia Silva Arbex</em>;
<em>Senicato, Caroline</em>;
<em>Malta, Deborah Carvalho</em>;
<br/><br/>
ABSTRACT OBJECTIVE To estimate the co-occurrence of the major risk factors for chronic diseases in adults (18-59 years old) and older people (≥ 60 years old) living in Brazilian state capitals and the Federal District. METHODS Cross-sectional study with population-based data from 35,448 adults and 18,726 older people collected in the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (System of Surveillance of Risk and Protective Factors for Chronic Diseases by Telephone Survey – Vigitel) in 2015. The prevalence of each of the five risk factors (smoking, overweight, physical inactivity, alcohol and unhealthy diet) was estimated, as well as their co-occurrence for the different possible combinations, according to socioeconomic and health self-assessment variables. The independent associations were verified via multinomial logistic regression to obtain the estimates of the odds ratio (OR) and corresponding 95% confidence intervals. RESULTS At least two risk factors were present in 38.5% of the adults and 37.0% of the older participants. The male adults and older participants who did not have private health insurance and classified their health as average or poor/very poor were more likely to have two or more concurrent risk behaviors. The greater chance of co-occurrence of smoking and alcohol abuse in adults (adjusted OR = 3.52) and older people (adjusted OR = 2.94) stands out. CONCLUSIONS The subgroups with increased risk of developing multiple unhealthy behaviors and the most prevalent behaviors were identified. These findings are expected to contribute to the better targeting of health promotion and preventive care. It is worth noting that, for the adoption of healthy lifestyle habits, macro-social and inter-sectoral policies are more effective.Factors associated with inadequate follow-up of children with congenital syphilis10.11606/s1518-8787.20190530012842017-01-30T00:05:00Z2017-01-30T00:05:00ZCavalcante, Ana Nery MeloAraújo, Maria Alix LeiteNobre, Marina ArraisAlmeida, Rosa Lívia Freitas de
<em>Cavalcante, Ana Nery Melo</em>;
<em>Araújo, Maria Alix Leite</em>;
<em>Nobre, Marina Arrais</em>;
<em>Almeida, Rosa Lívia Freitas De</em>;
<br/><br/>
ABSTRACT OBJECTIVE To analyze factors associated with outpatient follow-up of children with congenital syphilis. METHODS A non-concurrent cohort study performed in primary care units and three reference maternity hospitals in Fortaleza (Ceará State). Data were collected from September 2013 to September 2016 in the notification forms and in the medical records of hospitalization and outpatient follow-up, and they were presented considering an adequate and inadequate follow-up. Children who attended the primary care unit or referral outpatient clinic during the period recommended by the Ministry of Health were considered adequately followed up and performed the recommended examinations. Pearson’s chi-square and Fisher’s exact tests were used in the comparative analysis. The estimated risk of adequate non-follow-up was verified by simple and multiple logistic regression. RESULTS The total of 460 children with congenital syphilis were notified, of which 332 (72.2%) returned for at least one appointment and were part of the study. Exactly 287 (86.4%) children attended the primary health unit; however, there was no reference to congenital syphilis in 236 (71.1%) medical records and no information on the venereal disease research laboratory (VDRL) test was found in 264 (79.5%) children. There was nonadherence to subsequent appointments by 272 (81.9%) individuals. The following variables had a statistically significant association with the non-adequate follow-up of the children: marital status of the mothers, number of prenatal appointments, number of pregnancies, blood count, and radiography of long bones. CONCLUSIONS Most children with congenital syphilis attended primary care for follow-up, but the services do not meet the recommendations of the Brazilian Ministry of Health for adequate follow-up.Use of antibiotics in the health care unit: 2015 Pelotas Birth Cohort10.11606/s1518-8787.20190530014772017-01-30T00:05:00Z2017-01-30T00:05:00ZBertoldi, Andrea DâmasoMielke, Grégore IvenGuttier, Marília CruzNeumann, Nelson ArnsDalabona, CarolineBoing, Alexandra CrispimSilveira, Mariângela Freitas
<em>Bertoldi, Andrea Dâmaso</em>;
<em>Mielke, Grégore Iven</em>;
<em>Guttier, Marília Cruz</em>;
<em>Neumann, Nelson Arns</em>;
<em>Dalabona, Caroline</em>;
<em>Boing, Alexandra Crispim</em>;
<em>Silveira, Mariângela Freitas</em>;
<br/><br/>
ABSTRACT OBJECTIVE To estimate the use of the first dose of antibiotics in the health care unit in children from the 2015 Pelotas Birth Cohort at 24 months. METHODS A total of 4,014 children were monitored. We used descriptive statistics and Poisson regression to analyze the association between socioeconomic and demographic variables, participation in daycare units, in the activities of the Pastoral da Criança and in the Primeira Infância Melhor program, low birth weight, hospitalization between 12 and 24 months, place of medical appointment, prevalence of medical appointment in the last 30 days, prescription of antibiotics, and administration of the first dose in the health care unit. RESULTS A total of 1,044 children had medical appointments in the last 30 days, of which 45% were prescribed antibiotics and only 10.5% were administered the first dose of this medication in the health care unit. Children with brown, yellow or indigenous skin color were administered 2.5 times more antibiotics than white children. Children whose mothers had 12 years or more of education were administered 83.0% fewer antibiotics than those whose mothers had up to 4 years of education. Among those who were hospitalized for 12 to 24 months, the use of antibiotics was almost four times higher than among those who were not. Among the children served by the Brazilian Unified Health System (SUS), only 15.3% were administered the first dose of antibiotic in the health care unit. When compared with children served by private health care or health plan, administration of the first dose in the SUS was 76.0% higher. CONCLUSIONS Despite the efforts related to the Pastoral da Criança campaign “Antibiotic: first dose immediately,” adherence to the provision of antibiotics in the health care unit is still low. Strategies are necessary and urgent so children have access to the first dose of antibiotics in the health care unit.Brazilian generics market change after Farmácia Popular program10.11606/s1518-8787.20190530012372017-01-30T00:05:00Z2017-01-30T00:05:00ZBertoldi, Andréa DâmasoChaves, Luisa ArueiraRoss-Degnan, DennisLuiza, Vera LuciaEmmerick, Isabel Cristina MartinsSilva, Rondineli Mendes daCampos, Mônica Rodrigues
<em>Bertoldi, Andréa Dâmaso</em>;
<em>Chaves, Luisa Arueira</em>;
<em>Ross-Degnan, Dennis</em>;
<em>Luiza, Vera Lucia</em>;
<em>Emmerick, Isabel Cristina Martins</em>;
<em>Silva, Rondineli Mendes Da</em>;
<em>Campos, Mônica Rodrigues</em>;
<br/><br/>
ABSTRACT OBJECTIVE To evaluate trends in the use of generic and non-generic medicines to treat hypertension and diabetes under the Farmácia Popular Program (FP) and its impact on generic medicines sales volume and market share in the Brazilian pharmaceutical market. METHODS This longitudinal, retrospective study used interrupted time series design to analyze changes in monthly sales volume and proportion of medicines sales (market share) for oral antidiabetic and antihypertensive medicines for generic versus non-generic products. Analyses were conducted in a combined dataset that aggregate monthly sales volumes from the Farmácia Popular program and from the QuintilesIMS™ (IQVIA) national market sales data from January 2007 to December 2012. The Farmácia Popular program phases analyzed included: a) 2009 reductions in medicines reference prices (AFP-II) and b) 2011 implementation of free medicines program for hypertension and diabetes, the Saúde não tem preço (SNTP – Health has no price). RESULTS Patterns of use for FP-covered antidiabetic and antihypertensive medicines were similar to their use in the market in general. After one year of the decreases in government subsidies in April 2010, market share of antidiabetic and antihypertensive medicines experienced relative declines of -54.5% and -59.9%, respectively. However, when FP-covered medicines were made free to patients, overall market volume for antidiabetic and antihypertensive generics increased dramatically, with 242.6% and 277.0% relative increases by February 2012, as well as non-generics with relative increase of 209.7% and 279% for antidiabetic and antihypertensive medicines, respectively. CONCLUSIONS Ministry of Health policies on the amount of patient cost sharing and on the choice of medicines on coverage lists have substantial impacts on overall generic sales volume in retail pharmacies.Development and evaluation of food environment audit instrument: AUDITNOVA10.11606/s1518-8787.20190530013162017-01-30T00:05:00Z2017-01-30T00:05:00ZBorges, Camila AparecidaJaime, Patricia Constante
<em>Borges, Camila Aparecida</em>;
<em>Jaime, Patricia Constante</em>;
<br/><br/>
ABSTRACT OBJECTIVE To develop and assess the reliability of an instrument that enables auditing information on consumer food environment indicators, such as availability, price, promotional and advertising strategies, and quantity of brands available, using the food recommendations adopted by the Dietary Guidelines for the Brazilian Population as a theoretical basis. METHODS This is a methodological study in two phases: 1. development of the audit instrument and 2. assessment of its reliability and reproducibility . The Content Validity Index was estimated for each instrument item (>0.80 satisfactory). Inter-rater and test-retest reliability were assessed by percentage agreement and Kappa coefficients. Pearson’s correlation coefficient and Scatter-plots were used to measure the degree of linear correlation between two quantitative variables. RESULTS The Content Validity Index was 0.91. Inter-rater and test-retest reliability were mostly high (Kappa> 0.80), for food availability indicators. Among the items that measure advertising, Kappa values for inter-rater reliability ranged from 0.57 to 1.00 and for the test-retest ranged from 0.18 to 0.90. Prices and quantity of brands showed a positive linear correlation between measurements performed by researcher 1 and 2 and between visits 1 and 2. CONCLUSIONS AUDITNOVA is reliable for measuring aspects such as availability, price, quantity of brands, and advertising of foods available in the consumer food environment.Characterization of women with cervical cancer assisted at Inca by histological type10.11606/s1518-8787.20190530012182017-01-30T00:05:00Z2017-01-30T00:05:00ZRozario, Suelem doSilva, Iléia Ferreira daKoifman, Rosalina JorgeSilva, Ilce Ferreira da
<em>Rozario, Suelem Do</em>;
<em>Silva, Iléia Ferreira Da</em>;
<em>Koifman, Rosalina Jorge</em>;
<em>Silva, Ilce Ferreira Da</em>;
<br/><br/>
ABSTRACT OBJECTIVE To determine the distribution of sociodemographic, reproductive, clinical and lifestyle habits in the cohort of women diagnosed with cervical cancer, assisted at Inca between 2012 and 2014, according to the histological type. METHODS Retrospective observational study of a hospital cohort of 1,004 women diagnosed with cervical cancer. Data were obtained from the Inca hospital cancer registry, physical and electronic records. RESULTS The most frequent histological type was squamous cell carcinoma (83.9%). Approximately 70% of the women aged more than 40 years. The study includes non-white women (67.4%), with less than 8 years of education (51.9%), with onset of sexual activity up to 16 years of age (40.7%), who were pregnant before (95.5%), with more than one pregnancy (82.9%), and more than two children (52.7%); 45.8% of the women were smokers or former smokers. Cervical adenocarcinoma was positively associated with earlier staging (IA-IIA) (OR = 1.79; 95%CI 1.03–3.13), as well as women with ≥ 12 years of education (OR = 6.30; 95%CI 1.97–20,13), who had no children (OR = 3.81; 95%CI 1.20 – 12,08) or who had up to two children (OR = 1.74; 95%CI 1.05 – 2,87). CONCLUSIONS The difference between histological types is highlighted, suggesting that women with cervical adenocarcinoma may represent a distinct clinical entity of cervical neoplasia, which may require different approaches from those used in squamous cell carcinoma.HIV-AIDS prevention in the conception of HIV-positive young people10.11606/s1518-8787.20190530011742017-01-30T00:05:00Z2017-01-30T00:05:00ZTaquette, Stella ReginaSouza, Luciana Maria Borges da Matta
<em>Taquette, Stella Regina</em>;
<em>Souza, Luciana Maria Borges Da Matta</em>;
<br/><br/>
ABSTRACT OBJECTIVE To analyze the conception of seropositive young people on how to prevent HIV infection. METHODS This is a qualitative study using semi-structured interviews with HIV-positive young people whose diagnosis was made in adolescence 5 years ago or less. We followed a semi-structured script containing sociodemographic data and an open question on HIV/AIDS prevention. The interviews were recorded and fully transcribed, then analyzed with the support of the webQDA software. We used the categories that compose the concept of vulnerability as a theoretical basis for data analysis. RESULTS We interviewed 39 young people, 23 girls and 16 boys. Some perceive the prevention of HIV infection only as an individual issue, summarizing it to the use of condoms and self-care. Most of the interlocutors point out educational strategies as the most relevant for prevention but used in a permanent and non-punctual way. In schools, they believe it is necessary to include younger students and their family. Guidelines should be given by people who can use the language of young people and preferably by HIV-positive people, to show the reality of those who have AIDS. In the programmatic field, they suggest intensifying campaigns in the media, distributing condoms in large scale, producing vaccines and medicines that cure. No one mentioned the female condom, the rapid test, nor the availability of sexual and reproductive health care. CONCLUSIONS The qualification and expansion of communication strategies on sexuality in schools is urgent and essential in HIV and AIDS prevention in adolescence, contrary to the current trend of restricting the discussion of these topics in education policies.Quality of sleep, health and well-being in a population-based study10.11606/s1518-8787.20190530010672017-01-30T00:05:00Z2017-01-30T00:05:00ZBarros, Marilisa Berti de AzevedoLima, Margareth GuimarãesCeolim, Maria FilomenaZancanella, EdilsonCardoso, Tânia Aparecida Marchiori de Oliveira
<em>Barros, Marilisa Berti De Azevedo</em>;
<em>Lima, Margareth Guimarães</em>;
<em>Ceolim, Maria Filomena</em>;
<em>Zancanella, Edilson</em>;
<em>Cardoso, Tânia Aparecida Marchiori De Oliveira</em>;
<br/><br/>
ABSTRACT OBJECTIVE To estimate the prevalence of poor self-rated sleep and to identify the population subgroups most susceptible to the problem. METHODS This is a cross-sectional, population-based study developed with data from the Health Survey conducted in the city of Campinas (ISACamp 2014/2015). Data from a sample of 1,998 individuals aged 20 years or older were analyzed. The self-rated quality of sleep was analyzed according to socio-demographic characteristics, morbidities, health behaviors and feeling of well-being. The association of sleep quality with different complaints and characteristics of sleep was also analyzed. Adjusted prevalence ratios were estimed using Poisson multiple regression model allowing for the sample weights. RESULTS Prevalence of poor self-rated sleep was 29.1% and showed to be significantly higher in women, in individuals aged from 40 to 50 years, migrants, without occupation, physically inactive in leisure context, with common mental disorder (PR = 1.59), with greater number of health problems (PR = 2.33), poor self-rated health (PR = 1.61), and life dissatisfaction. Poor sleep was strongly associated with reports of difficulty in initiating sleep (PR = 4.17), in maintaining sleep (PR = 4.40) and with never or almost never feeling well when waking up (PR = 4.52). CONCLUSIONS The results identify the population subgroups with poor quality of sleep that deserve greater attention. It also highlight the need to consider, in addition to the presence of comorbidities, mental health and the feeling of well-being in the care of patients with sleep problems and in the interventions planed for promoting healthy sleep.Epidemiological overview – 18 years of ICU hospitalization due to trauma in Brazil10.11606/s1518-8787.20190530011782017-01-30T00:05:00Z2017-01-30T00:05:00ZLentsck, Maicon HenriqueSato, Ana Paula SayuriMathias, Thais Aidar de Freitas
<em>Lentsck, Maicon Henrique</em>;
<em>Sato, Ana Paula Sayuri</em>;
<em>Mathias, Thais Aidar De Freitas</em>;
<br/><br/>
ABSTRACT OBJECTIVE Assess the magnitude and trend of hospitalization rates due to traumatic injuries in intensive care units (ICU) in Brazil from 1998 to 2015. METHODS This is an ecological time-series study that analyzed data from the Hospital Information System. A trend analysis of hospitalization rates was performed according to diagnosis, sex and age using generalized linear regression models and Prais-Winsten estimation. RESULTS Rates were higher among male patients, but increased hospitalization due to trauma among female patients influenced the ratio between both sexes. Falls and transport accidents were the most frequent causes of trauma. The average annual growth was 3.6% in ICU trauma hospitalization rates in Brazil, the highest growth was reported in the North region (8%; 95%CI 6.4-9.6), among women (5.4%; 95%CI 4.5-6.3), and among people aged 60 years and older (5.5%; 95%CI, 4.7-6.3). The most frequent causes of trauma are falls (4.5%; 95%CI 3.5-5.5) and care complications (5.4%; 95%CI 4.5-6.3). On the other hand, the annual hospital mortality rate due to trauma in ICU is 1.7% lower, on average (95%CI 2.1-1.3). CONCLUSION An increase in ICU hospitalization rate due to trauma in Brazil may be the result of some factors, such as an increasing number of accidents and cases of violence, the implementation of pre-hospital care, and improved access to care, with more beds in ICU. In addition, population aging is another factor, as a greater increase in hospitalization was observed among people aged 60 years and older.Work ability of military police officers10.11606/s1518-8787.20190530010142017-01-30T00:05:00Z2017-01-30T00:05:00ZBarreto, Carla RequiãoLins-Kusterer, LilianeCarvalho, Fernando Martins
<em>Barreto, Carla Requião</em>;
<em>Lins-Kusterer, Liliane</em>;
<em>Carvalho, Fernando Martins</em>;
<br/><br/>
ABSTRACT OBJECTIVE To determine the prevalence of work ability (WA) and describe characteristics of the subgroup with poor WA among military police officers. METHODS A descriptive and cross-sectional study with 329 male military police officers engaged in street patrolling in Salvador, Bahia, Brazil, selected by proportionate stratified sampling. The Work Ability Index and a structured form were used to collect information about age, education, marital status, housing, salary, car ownership, work hours, rank (official or enlisted), drinking, smoking, frequency of vigorous physical activity, and obesity. Data were analyzed by uni and bivariate statistical techniques. RESULTS The work ability of the 329 military police officers was classified as poor (10.3%), moderate (28.9%), good (34.7%), and excellent (26.1%), with mean score of 37.8 and standard deviation of 7.3 points. Policemen with poor work ability, compared with those with moderate, good or excellent WA, presented higher proportions of individuals who did not own their residences (p < 0.001), with work hours above eight hours/day (p < 0.026), and obesity (p < 0.001). In the subgroup of the 26 policemen who concomitantly did not own their residences, worked more than eight 8 hours/day and were obese, the prevalence of poor work ability was 31.0%. The prevalence of poor WA was 31.0% among the 29 policemen who were simultaneously obese and did not own their residences and of 27.9% among the 43 policemen who were obese and work hours above eight hours/day. CONCLUSIONS A high percentage of military police officers from Salvador presented poor or moderate work ability, which may hamper or compromise their policing activities. The prevalence of poor work ability was higher among the policemen who did not own their residences, worked more than 8 hours/day and were obese.Vectors of arboviruses in the state of São Paulo: 30 years of Aedes aegypti and Aedes albopictus10.11606/s1518-8787.20190530012642017-01-30T00:05:00Z2017-01-30T00:05:00ZFonseca Júnior, Dalton Pereira daSerpa, Lígia Leandro NunesBarbosa, Gerson LaurindoPereira, MarizaHolcman, Marcia MoreiraVoltolini, Júlio CesarMarques, Gisela Rita Alvarenga Monteiro
<em>Fonseca Júnior, Dalton Pereira Da</em>;
<em>Serpa, Lígia Leandro Nunes</em>;
<em>Barbosa, Gerson Laurindo</em>;
<em>Pereira, Mariza</em>;
<em>Holcman, Marcia Moreira</em>;
<em>Voltolini, Júlio Cesar</em>;
<em>Marques, Gisela Rita Alvarenga Monteiro</em>;
<br/><br/>
ABSTRACT OBJECTIVE To describe the infestation of the municipalities of São Paulo by the vectors Aedes aegypti and Aedes albopictus, characterize seasonality and analyze average temperatures and larval densities. METHODS We used maps with information on the infestation of municipalities between 1986 and 2015. The analysis of larval density of the species by the Wilcoxon test used the Breteau index values for Ae. aegypti and Ae. albopictus obtained from the Superintendency for Endemic Diseases Control database. In the seasonal description, arithmetic means of each vector were calculated by month and year. Mean temperature analyses were presented on maps with color gradients. RESULTS The state of São Paulo is currently almost totally infested, with co-occurrence of species in 93.64% of the municipalities. The seasonality analysis showed the first quarter as the most favorable period for larval abundance. The increase of mean temperatures in geographical areas coincided with the temporal trajectory of Ae. aegypti territorial expansion. The mean larval density found was higher for Ae. aegypti than for Ae. albopictus (p = 0.00). CONCLUSIONS Initially, these Culicidae occupied distinct and opposing areas. Over time, however, co-occurrence showed how great their capacity for adaptation is, even in the face of different social and urban conjunctures. The increase of the mean temperature contributed to Ae. Aegypti ’s geographic expansion, as well as to the clearly seasonal profile of both species. In general, larval infestation by Ae. aegypti prevailed, which evidenced its competitive superiority. These data provide a better understanding of the dynamics of arboviral transmission in the state of São Paulo and can be used in vector surveillance and control.User satisfaction in the spanish health system: trend analysis10.11606/s1518-8787.20190530015062017-01-30T00:05:00Z2017-01-30T00:05:00ZPérez-Cantó, VíctorMaciá-Soler, LoretoGonzález-Chordá, Víctor M
<em>Pérez-Cantó, Víctor</em>;
<em>Maciá-Soler, Loreto</em>;
<em>González-Chordá, Víctor M</em>;
<br/><br/>
ABSTRACT OBJECTIVE To analyze the trend of opinion and satisfaction indicators of the Spanish national health system from 2005 to 2017. METHODS Ecological study of time series analyzing the trend of eight indicators of opinion and satisfaction on the Spanish national health system and its autonomous communities from 2005 to 2017. The data was obtained from the Ministry of Health, Social Services and Equality and from the Health Barometer. The Prais-Winsten regression method was used. RESULTS A static tendency was observed in the perception of users on how the health system works (APC = 1.898, 95%CI -0.954 – 4.751) and decreasing opinion on the improvement of primary care (APC = -0.283; 95%CI -0.335 – -0.121), specialized (APC = -0.241, 95%CI -0.74 – -0.109) and hospitalization (APC = -0.171, 95%CI -0.307 – -0.036). Satisfaction with knowledge and follow-up by the family doctor and pediatrician showed an increasing trend (APC = 7.939, 95%CI 3.965 – 11.914). Satisfaction with medical and nursing professionals was static. No large differences were observed in the trends of the indicators studied in the autonomous communities. CONCLUSIONS A negative trend was observed in the opinion of the Spanish national health system users. Financing, human resources, quality management systems and differences in the autonomous communities may be some of the causes.Group prenatal care: effectiveness and challenges to implementation10.11606/s1518-8787.20190530013032017-01-30T00:05:00Z2017-01-30T00:05:00ZAndrade-Romo, ZafiroHeredia-Pi, Ileana B.Fuentes-Rivera, EvelynAlcalde-Rabanal, JacquelineCacho, Lourdes Bravo BolañosJurkiewicz, LaurieDarney, Blair G.
<em>Andrade-Romo, Zafiro</em>;
<em>Heredia-Pi, Ileana B.</em>;
<em>Fuentes-Rivera, Evelyn</em>;
<em>Alcalde-Rabanal, Jacqueline</em>;
<em>Cacho, Lourdes Bravo Bolaños</em>;
<em>Jurkiewicz, Laurie</em>;
<em>Darney, Blair G.</em>;
<br/><br/>
ABSTRACT Group prenatal care is an alternative model of care during pregnancy, replacing standard individual prenatal care. The model has shown maternal benefits and has been implemented in different contexts. We conducted a narrative review of the literature in relation to its effectiveness, using databases such as PubMed, EBSCO, Science Direct, Wiley Online and Springer for the period 2002 to 2018. In addition, we discussed the challenges and solutions of its implementation based on our experience in Mexico. Group prenatal care may improve prenatal knowledge and use of family planning services in the postpartum period. The model has been implemented in more than 22 countries and there are challenges to its implementation related to both supply and demand. Supply-side challenges include staff, material resources and organizational issues; demand-side challenges include recruitment and retention of participants, adaptation of material, and perceived privacy. We highlight specific solutions that can be applied in diverse health systems.Is living near green areas beneficial to mental health? Results of the Pró-Saúde Study10.11606/s1518-8787.20190530010082017-01-30T00:05:00Z2017-01-30T00:05:00ZBarreto, Patricia AmadoLopes, Claudia SouzaSilveira, Ismael Henrique daFaerstein, EduardoJunger, Washington Leite
<em>Barreto, Patricia Amado</em>;
<em>Lopes, Claudia Souza</em>;
<em>Silveira, Ismael Henrique Da</em>;
<em>Faerstein, Eduardo</em>;
<em>Junger, Washington Leite</em>;
<br/><br/>
ABSTRACT OBJECTIVE To investigate the association between exposure to green areas in the surroundings of the residence and the presence of common mental disorders among adults, according to different income strata. METHODS Cross-sectional study with 2,584 participants from the Pró-Saúde Study (2006), residing in the city of Rio de Janeiro. Common Mental Disorders were measured using the General Health Questionnaire (GHQ-12) and exposure to green areas was measured using the normalized difference vegetation index, in buffers with radiuses between 100 and 1,500 meters around the residence. We used the mean and maximum normalized difference vegetation index categorized into quartiles. The study population was divided into three subgroups, according to the income: low, intermediate, and high. Odds ratios and their 95% confidence intervals were estimated with logistic regression models. The models were adjusted by sex and age, with and without inclusion of physical activity practice. RESULTS The proportion of common mental disorders was 30% and 39% among men and women, respectively. The results of the adjusted models showed an inverse association between the presence of green areas in the surroundings of the residence and the occurrence of common mental disorders, in the buffer of 200 meters in the intermediate-income group and in the buffers of 400 and 1,500 meters in the low-income group. The odds ratio ranged from 0.52 (buffer of 1,500 meters) to 0.68 (buffer of 200 meters). The association found was independent of physical activity practice. CONCLUSIONS The evidence found suggests the existence of a beneficial effect of urban green areas on the mental health of lower-income individuals. These findings can help in understanding how the urban environment can affect the mental health of the population.Most-cited public health articles of scientific journals from Brazil10.11606/s1518-8787.20190530015542017-01-30T00:05:00Z2017-01-30T00:05:00ZBarbosa, Milena Maria de Araújo LimaCuenca, Angela Maria BelloniOliveira, Karoline deFrança Junior, IvanAlvarez, Maria do Carmo AvamilanoOmae, Larissa Yuko
<em>Barbosa, Milena Maria De Araújo Lima</em>;
<em>Cuenca, Angela Maria Belloni</em>;
<em>Oliveira, Karoline De</em>;
<em>França Junior, Ivan</em>;
<em>Alvarez, Maria Do Carmo Avamilano</em>;
<em>Omae, Larissa Yuko</em>;
<br/><br/>
ABSTRACT OBJECTIVE To describe the most-cited articles in public health scientific journals edited in Brazil. METHODS Articles published between 2008 and 2010 by public health journals edited in Brazil and indexed in the Scopus database were included, and citations received up to five years after publication were ranked. We studied a total of 105 articles, as the last seven articles shared the same number of citations and so were given the same rank. RESULTS The most-cited articles received a median of 28 citations, and the distribution ranged from 22 to 95 citations. These articles describe advances in the areas of Epidemiology (74%), Health Policies, Planning and Administration (19%), and Social and Human Sciences in Health (7%). Only half mentioned that they have received funding. About 75% of the articles were written by three or more authors and 90%, by authors affiliated to public institutions such as universities and government organizations. Fifteen individuals were responsible for authoring or coauthoring three or more of the 105 articles studied. The journals Cadernos de Saúde Pública, Revista de Saúde Pública, and Ciência & Saúde Coletiva have published the vast majority of the most-cited articles in the area (94%). CONCLUSIONS In Brazil, the most-cited articles in public health mainly report Epidemiology research, are written by groups of authors and by researchers affiliated to public institutions and are published in journals with a greater impact. Periodical analyses of these data can show potential changes in the characteristics of articles that most attract public health scientists.Factors associated with prenatal care and HIV and syphilis testing during pregnancy in primary health care10.11606/s1518-8787.20190530012052017-01-30T00:05:00Z2017-01-30T00:05:00ZFreitas, Cláudia Helena Soares de MoraisForte, Franklin Delano SoaresRoncalli, Angelo GiuseppeGalvão, Maria Helena RodriguesCoelho, Ardigleusa AlvesDias, Sonia Maria Ferreira
<em>Freitas, Cláudia Helena Soares De Morais</em>;
<em>Forte, Franklin Delano Soares</em>;
<em>Roncalli, Angelo Giuseppe</em>;
<em>Galvão, Maria Helena Rodrigues</em>;
<em>Coelho, Ardigleusa Alves</em>;
<em>Dias, Sonia Maria Ferreira</em>;
<br/><br/>
ABSTRACT OBJECTIVE To evaluate the factors associated with HIV and syphilis testing during pregnancy in Brazil. METHODS This was an ecological study covering all Brazilian municipalities evaluated by the second cycle of the National Program for Access and Quality Improvement in Primary Care, 2013-2014. The dependent variables were based on prenatal care access: prenatal care appointments, and HIV and syphilis tests during prenatal care. The independent variables were compared with demographic and social characteristics. Bivariate analysis was performed assessing the three outcomes with the independent variables. Variables with significant associations in this bivariate analysis were fit in a Poisson multiple regression analysis with robust variance to obtain adjusted estimates. RESULT Poisson regression analysis showed a statistically significant association with the variables “less than eight years of study” [prevalence ratio (PR) = 1.31; 95%CI 1.19–1.45; p < 0.001] and “participants of the cash transfer program” (PR = 0.80; 95%CI 0.72–0.88; p < 0.001) for the outcome of “having less than six prenatal care appointments” and individual variables. A statistically significant association was found for “participants of the cash transfer program” (PR = 1.43; 95%CI 1.19–1.72; p < 0.001) regarding the outcome from the comparison between HIV testing absence during prenatal care and demographic and social characteristics. The absence of syphilis testing during prenatal care, and demographic and social characteristics presented a statistically significant association for the education level variable “less than eight years of study” (PR =1.75; 95%CI 1.56–1.96; p < 0.001) and “participants of the cash transfer program” (PR = 1.21, 95%CI 1.07–1.36; p < 0.001). CONCLUSIONS The individual factors were associated with prenatal care appointments and HIV and syphilis tests in Brazilian pregnant women. They show missed opportunities for diagnosing HIV and syphilis infection during prenatal care and indicate weaknesses in the quality of maternal health care services to eliminate mother-to-child transmission.Predictive model of unfavorable outcomes for multidrug-resistant tuberculosis10.11606/s1518-8787.20190530011512017-01-30T00:05:00Z2017-01-30T00:05:00ZArroyo, Luiz HenriqueRamos, Antônio Carlos VieiraYamamura, MellinaBerra, Thais ZamboniAlves, Luana SelesBelchior, Aylana de SouzaSantos, Danielle TalitaAlves, Josilene DáliaCampoy, Laura TerencianiArcoverde, Marcos Augusto MoraesBollela, Valdes RobertoBombarda, SidneyNunes, CarlaArcêncio, Ricardo Alexandre
<em>Arroyo, Luiz Henrique</em>;
<em>Ramos, Antônio Carlos Vieira</em>;
<em>Yamamura, Mellina</em>;
<em>Berra, Thais Zamboni</em>;
<em>Alves, Luana Seles</em>;
<em>Belchior, Aylana De Souza</em>;
<em>Santos, Danielle Talita</em>;
<em>Alves, Josilene Dália</em>;
<em>Campoy, Laura Terenciani</em>;
<em>Arcoverde, Marcos Augusto Moraes</em>;
<em>Bollela, Valdes Roberto</em>;
<em>Bombarda, Sidney</em>;
<em>Nunes, Carla</em>;
<em>Arcêncio, Ricardo Alexandre</em>;
<br/><br/>
ABSTRACT OBJECTIVE to analyze the temporal trend, identify the factors related and elaborate a predictive model for unfavorable treatment outcomes for multidrug-resistant tuberculosis (MDR-TB). METHODS Retrospective cohort study with all cases diagnosed with MDR-TB between the years 2006 and 2015 in the state of São Paulo. The data were collected from the state system of TB cases notifications (TB-WEB). The temporal trend analyzes of treatment outcomes was performed through the Prais-Winsten analysis. In order to verify the factors related to the unfavorable outcomes, abandonment, death with basic cause TB and treatment failure, the binary logistic regression was used. Pictorial representations of the factors related to treatment outcome and their prognostic capacity through the nomogram were elaborated. RESULTS Both abandonment and death have a constant temporal tendency, whereas the failure showed it as decreasing. Regarding the risk factors for such outcomes, using illicit drugs doubled the odds for abandonment and death. Besides that, being diagnosed in emergency units or during hospitalizations was a risk factor for death. On the contrary, having previous multidrug-resistant treatments reduced the odds for the analyzed outcomes by 33%. The nomogram presented a predictive model with 65% accuracy for dropouts, 70% for deaths and 80% for failure. CONCLUSIONS The modification of the current model of care is an essential factor for the prevention of unfavorable outcomes. Through predictive models, as presented in this study, it is possible to develop patient-centered actions, considering their risk factors and increasing the chances for cure.The ability of waist-to-height ratio to identify health risk10.11606/s1518-8787.20190530008952017-01-30T00:05:00Z2017-01-30T00:05:00ZCorrêa, Márcia MaraFacchini, Luiz AugustoThumé, ElaineOliveira, Elizabete Regina Araújo deTomasi, Elaine
<em>Corrêa, Márcia Mara</em>;
<em>Facchini, Luiz Augusto</em>;
<em>Thumé, Elaine</em>;
<em>Oliveira, Elizabete Regina Araújo De</em>;
<em>Tomasi, Elaine</em>;
<br/><br/>
ABSTRACT OBJECTIVE To evaluate the performance of the ratio between the waist circumference and the height in the identification of health risk compared with the correlation matrix between the anthropometric parameters body mass index and waist circumference. METHODS A population-based study presenting a transversal cut in a representative sample of the Brazilian adult and older population. The combination of the body mass index with the waist circumference resulted in health risk categories, and the cutoff points of the ratio between the waist circumference and the height as anthropometric indicator were used for classification of low and increased risk. Poisson regression was used to verify the association of systemic arterial hypertension with the health risk categories. RESULTS The results showed 26% of adult men, 10.4% of adult women and more than 30% of the older adults of both genders classified as without risk by the combination matrix between body mass index and waist circumference presented a ratio between the waist circumference and height that showed increased risk. All risk categories continued to be associated with hypertension after control for confounding factors, being almost two times higher for adults with moderate and high risk according to both methods. When the waist-to-height ratio was used as a risk indicator, the prevalence of hypertension ratios for the older adults was 1.37 (95%CI 1.16–1.63) and 1.35 (95%CI 1.12–1.62) for men and women, respectively, being these values close to the combination matrix body mass index and waist circumference. CONCLUSIONS The waist-to-height ratio identified more individuals at early health risk than the combination matrix between the body mass index and the waist circumference and showed comparable ability to identify health risk, regardless of gender and age, regarding the prevalence ratios for systemic arterial hypertension.Prevalence of sexual violence among refugees: a systematic review10.11606/s1518-8787.20190530010812017-01-30T00:05:00Z2017-01-30T00:05:00ZAraujo, Juliana de OliveiraSouza, Fernanda Mattos deProença, RaquelBastos, Mayara LisboaTrajman, AneteFaerstein, Eduardo
<em>Araujo, Juliana De Oliveira</em>;
<em>Souza, Fernanda Mattos De</em>;
<em>Proença, Raquel</em>;
<em>Bastos, Mayara Lisboa</em>;
<em>Trajman, Anete</em>;
<em>Faerstein, Eduardo</em>;
<br/><br/>
ABSTRACT OBJECTIVE To synthesize data about the prevalence of sexual violence (SV) among refugees around the world. METHODS A systematic review was conducted from the search in seven bibliographic databases. Studies on the prevalence of SV among refugees and asylum seekers of any country, sex or age, whether in English, French, Spanish and Portuguese, were eligible. RESULTS Of the 2,906 titles found, 60 articles were selected. The reported prevalence of SV was largely variable (0% to 99.8%). Reports of SV were collected in all continents, with 42% of the articles mentioning it in refugees from Africa (prevalence from 1.3% to 100%). The rape was the most reported SV in 65% of the studies (prevalence from 0% to 90.9%). The main victims were women in 89% of the studies, all the way, especially when still in the countries of origin. The SV was perpetrated particularly by intimate partners, but also by agents of supposed protection. Few studies have reported SV in men and children; the prevalence reached up to 39.3% and 90.9%, respectively. Approximately one-third of the studies (32%) were carried out in refugee camps and more than half (52%) in health services using mental health assessment tools. No study has addressed the most recent migratory crisis. Meta-analysis was not performed due to the methodological heterogeneity of the studies. CONCLUSIONS SV is a prevalent problem affecting refugees of both sexes, of all ages, throughout the migratory journey, particularly those from Africa. Protection measures are urgently needed, and further studies, with more appropriate tools, may better measure the current magnitude of the problem.Impact of lian gong on the quality of life of individuals with dizziness in primary care10.11606/s1518-8787.20190530012342017-01-30T00:05:00Z2017-01-30T00:05:00ZLopes, Aline LamasLemos, Stela Maris AguiarFigueiredo, Pedro Henrique ScheidtSantos, Juliana Nunes
<em>Lopes, Aline Lamas</em>;
<em>Lemos, Stela Maris Aguiar</em>;
<em>Figueiredo, Pedro Henrique Scheidt</em>;
<em>Santos, Juliana Nunes</em>;
<br/><br/>
ABSTRACT OBJECTIVE To assess the effects of the lian gong practice as a rehabilitation strategy in primary health care on the quality of life and functional capacity of people with dizziness. METHODS Randomized controlled clinical trial. Thirty-six people, who were complaining of dizziness or vertigo without the presence of central signs and were referred by the physician of primary health care participated in the study. The individuals were randomly allocated to the three experimental conditions: lian gong group (n = 11), vestibular rehabilitation group (n = 11) and control group (n = 14). The interventions were weekly, in group, with duration of 12 sessions. The participants were evaluated before and after the intervention regarding quality of life by the 36-Item Short Form Health Survey and the functional capacity by the Short Physical Performance Battery. RESULTS The scores of all domains of the Short Form Health Survey increased after intervention in the lian gong group. This variation was higher than that observed in the control group for the domains functional capacity, limitation by physical aspects and general health status, and also higher than that found after the intervention in the Vestibular Rehabilitation Group regarding pain. No differences were found in the Short Physical Performance Battery. CONCLUSIONS Based on the results presented, lian gong improves the quality of life of individuals with dizziness, without altering the functional capacity.Epidemiological aspects of HIV infection and AIDS among indigenous populations10.11606/s1518-8787.20190530003622017-01-30T00:05:00Z2017-01-30T00:05:00ZGraeff, Samara Vilas-BôasPícolli, Renata PalópoliArantes, RuiCastro, Vivianne de Oliveira Landgraf deCunha, Rivaldo Venâncio da
<em>Graeff, Samara Vilas-Bôas</em>;
<em>Pícolli, Renata Palópoli</em>;
<em>Arantes, Rui</em>;
<em>Castro, Vivianne De Oliveira Landgraf De</em>;
<em>Cunha, Rivaldo Venâncio Da</em>;
<br/><br/>
ABSTRACT OBJECTIVE To describe the epidemiological aspects of HIV infection and AIDS among indigenous peoples of the state of Mato Grosso do Sul, Brazil. METHODS This is a descriptive epidemiological study on the occurrence and distribution of HIV infection and AIDS in the indigenous population assisted by the Distrito Sanitário Especial Indígena (Indigenous Special Health District) Mato Grosso do Sul between 2001 and 2014, based on three secondary databases. Annual rates of HIV and AIDS detection and prevalence were calculated, considering case distribution according to village, Health Base Pole and sociodemographic variables. Accumulated rates of detection, mortality and case fatality were calculated by ethnic group and for the Health Base Pole with the highest number of cases. RESULTS The HIV detection rate fluctuated between 0.0 and 18.0/100 thousand people in the study period. For AIDS, there was no notification before 2007, but in 2012 its rate reached 16.6/100 thousand. HIV prevalence grew between 2001 and 2011, and it continuously grew for AIDS starting from 2007. The highest HIV detection rates occurred among Guarani peoples (167.1/100 thousand) and for AIDS, among the Kaiowá peoples (79.3/100 thousand); mortality and fatality rates were higher among the Kaiowá. Regarding the Dourados Health Base Pole, the AIDS detection rate increased, and the mortality and fatality rates decreased. CONCLUSIONS HIV infection and AIDS have been increasing among indigenous peoples, with distribution of the disease mainly in the Health Base Poles of the southern region of the state, where greater economic and social vulnerability are also observed. The endemic character of HIV and AIDS can become epidemic in some years given the existence of cases in other villages in the state. Its occurrence among the Guarani and Kaiowá populations indicates the need for expanded diagnosis, access to treatment and prevention measures.The development of transversal competence of health service managers10.11606/s1518-8787.20190530012922017-01-30T00:05:00Z2017-01-30T00:05:00ZDuarte, Roberto GonzalezMiura, Irene KazumiSawada, Namie OkinoAlves, MariliaPetrin, Renata
<em>Duarte, Roberto Gonzalez</em>;
<em>Miura, Irene Kazumi</em>;
<em>Sawada, Namie Okino</em>;
<em>Alves, Marilia</em>;
<em>Petrin, Renata</em>;
<br/><br/>
ABSTRACT In their pedagogical projects, health management courses focus on multidisciplinarity, interdisciplinarity, comprehensiveness and transversality, whose main merit is to question health issues from different theoretical perspectives. Analyzing these issues under many perspectives does not necessarily mean the development of transversal competences. The development and application of these competences suppose going beyond integrating curricular contents and theory/practice. They depend on how the knowledge will be articulated to changes at organizational, sectorial and institutional levels and on the coevolution between these competences and changes. It is understood that health services manager role is effectively transversal when he/she: (i) acts at organizational boundaries, fostering interaction between organizations and other actors in the system; (ii) provides (and receives) feedback to (and from) these actors; and (iii) these feedbacks help decision makers to undertake organizational changes to respond to the environment and shape it.Personal protective measures of pregnant women against Zika virus infection10.11606/s1518-8787.20190530011462017-01-30T00:05:00Z2017-01-30T00:05:00ZMelo, Vladimir Antonio DantasSilva, José Rodrigo SantosCorte, Roseli La
<em>Melo, Vladimir Antonio Dantas</em>;
<em>Silva, José Rodrigo Santos</em>;
<em>Corte, Roseli La</em>;
<br/><br/>
ABSTRACT OBJECTIVE To evaluate the adherence of pregnant women to personal protective measures against mosquito bites, recommended by the Ministry of Health, and to investigate the factors associated with the non-adoption of these measures. METHODS We interviewed 177 pregnant women between November 2016 and February 2017 in the 10 basic health units of the municipality of Propriá, state of Sergipe, two located in the rural area and eight in the urban area, during prenatal appointments, to raise information about the use of preventive measures against the vector transmission of Zika virus. Data were analyzed using descriptive statistical methods, chi-square test or Fisher’s exact test, and the odds ratio was calculated. The independent variables were grouped by the analysis of principal components, and the dependents (the use of repellent, mosquito nets, garments, screens and insecticides) were analyzed using the logistic regression method. RESULTS Among the measures recommended by the Ministry of Health, mosquito nets were the most used by pregnant women living in rural areas and with low education level, while the repellents were more used by women in the urban area and with higher education level. Women in a vulnerable socio-economic situation presented a risk 2.4 times higher for not using screens in their homes, 1.9 times higher for not changing clothes and 2.5 times higher for not using repellent than pregnant women in better economic conditions. CONCLUSIONS The socioeconomic status of pregnant women, especially among the less privileged, influenced the use of protective measures against Zika virus, from the purchase of repellent, clothing, insecticides to other resources in the municipality of Propriá, SE.Factors associated with the length of hospital stay of women undergoing cesarean section10.11606/s1518-8787.20190530011132017-01-30T00:05:00Z2017-01-30T00:05:00ZPereira, Samire LopesSilva, Thales Philipe Rodrigues daMoreira, Alexandra DiasNovaes, Taiane GonçalvesPessoa, Milene CristineMatozinhos, Isabela PenidoCouto, Renato CamargoPedrosa, Tânia Moreira GrilloMatozinhos, Fernanda Penido
<em>Pereira, Samire Lopes</em>;
<em>Silva, Thales Philipe Rodrigues Da</em>;
<em>Moreira, Alexandra Dias</em>;
<em>Novaes, Taiane Gonçalves</em>;
<em>Pessoa, Milene Cristine</em>;
<em>Matozinhos, Isabela Penido</em>;
<em>Couto, Renato Camargo</em>;
<em>Pedrosa, Tânia Moreira Grillo</em>;
<em>Matozinhos, Fernanda Penido</em>;
<br/><br/>
ABSTRACT OBJECTIVE To evaluate whether age group, complications or comorbidities are associated with the length of hospitalization of women undergoing cesarean section. METHODS A cross-sectional study was carried out between June 2012 and July 2017, with 64,437 women undergoing cesarean section and who did not acquire conditions during their hospital stay. Hospital discharge data were collected from national health institutions, using the Diagnosis-Related Groups system (DRG Brasil®). The DRG referring to cesarean section with additional complications or comorbidities (DRG 765) and cesarean section without complications or associated comorbidities (DRG 766) were included in the initial diagnosis. The influence of age group and comorbidities or complications present at admission on the length of hospital stay was assessed based on the means of the analysis of variance. The size of the effect was verified by Cohen’s D, which allows evaluating clinical relevance. The criticality levels were identified using the Duncan test. RESULTS The longest length of hospital stay was observed in the age group from 15 to 17 years old and among those aged 45 years old or more. The hospital stay of women with complications or comorbidities at the time of admission was also longer. Moreover, it was noted that the increase in criticality level was associated with an increase in the mean length of hospital stay. CONCLUSIONS The length of hospital stay of women is higher among those belonging to the age group ranging from 15 to 17 years old and for those aged 45 years old or more. The presence of associated comorbidities, such as eclampsia, pre-existing hypertensive disorder with superimposed proteinuria and gestational hypertension (induced by pregnancy) with significant proteinuria increase the length of hospital stay. This study enabled the construction of distinct criticality level profiles based on the combination of age groups and the main comorbidities, which were directly related to the length of hospital stay.Potential years of life lost due to oropharyngeal cancer in Brazil: 1979 to 201310.11606/s1518-8787.20190530010542017-01-30T00:05:00Z2017-01-30T00:05:00ZPerea, Lillia Magali EstradaBoing, Alexandra CrispimPeres, Marco AurélioBoing, Antonio Fernando
<em>Perea, Lillia Magali Estrada</em>;
<em>Boing, Alexandra Crispim</em>;
<em>Peres, Marco Aurélio</em>;
<em>Boing, Antonio Fernando</em>;
<br/><br/>
ABSTRACT OBJECTIVE To estimate the years of life lost by the Brazilian population due to mouth and pharynx cancer from 1979 to 2013, and analyze the temporal trends in the studied period, according to the country’s region, sex and anatomical site. METHODS The death records were obtained from the Mortality Information System and the data referring to the population, from the censuses of the Brazilian Institute of Geography and Statistics of 1980, 1991, 2000, 2010, and from intercensal estimates for the other years. The rates of potential years of life lost were calculated by applying the method suggested by Romeder and McWhinnie, and their trends were calculated using the Prais-Winsten method with first-order autocorrelation. The historical series were smoothed with the centered moving average technique of third order for white noise reduction. RESULTS In the period from 1979 to 2013 in Brazil, there were a total of 107,506 premature deaths due to mouth and pharynx cancer, which generated a total of 1,589,501 potential years of life lost, the equivalent to a rate of 3.6 per 10,000 inhabitants. Males, whose rate was six times higher than for females, contributed with 85% of the years lost. The trends in the rates of years of life lost showed an annual 0.72% increase for men, 1.13% for women and 1.05% for pharynx cancer. CONCLUSIONS The rate of potential years of life lost due to mouth and pharynx cancer in the country showed an upward trend within the studied period for both sexes, as well as for pharynx cancer and for the North, Northeast and Midwest regions.Qualitative evaluation of an intervention to reduce energy poverty10.11606/s1518-8787.20190530012122017-01-30T00:05:00Z2017-01-30T00:05:00ZJacques-Aviñó, ConstanzaDvorzak, José LuisMarí-Dell’Olmo, MarcArjona, Dolors RodriguezPeralta, AndrésCarrere, JuliBenach, JoanRamos, CristinaPlana, MònicaLópez, María José
<em>Jacques-Aviñó, Constanza</em>;
<em>Dvorzak, José Luis</em>;
<em>Marí-Dell’olmo, Marc</em>;
<em>Arjona, Dolors Rodriguez</em>;
<em>Peralta, Andrés</em>;
<em>Carrere, Juli</em>;
<em>Benach, Joan</em>;
<em>Ramos, Cristina</em>;
<em>Plana, Mònica</em>;
<em>López, María José</em>;
<br/><br/>
ABSTRACT OBJECTIVE To evaluate the “ Energía, la justa ” program, aimed at reducing energy poverty in the city of Barcelona, from the point of view of the target population and the workers involved in the intervention. METHODS A qualitative, descriptive and exploratory pilot study was carried out, with a phenomenological approach. Twelve semi-structured interviews were conducted: to three users, three energy agents who performed interventions in the homes, and six professionals who participated in the program coordination. A thematic content analysis was carried out using Atlas-ti software . Interviews were conducted between October 2016 and March 2017. RESULTS Trust in a contact person (e.g. social workers) facilitated the participation, although there were difficulties reaching people who had illegal energy supplies, immigrant women or immigrants who subrent properties. Regarding implementation, home visits, energy efficiency advice and the relationship with energy agents were the best assessed aspects. However, not being able to carry out reforms in deteriorated dwellings was considered a limitation. The program also contributed to raise awareness on energy rights, to save on utility bills and to generate tranquility and social support. CONCLUSIONS Programs such as this one can promote energy empowerment and improve psychosocial status. However, strategies with a gender and equity perspective should be considered to reach other vulnerable groups.Monotony in the consumption of fruits and vegetables and food environment characteristics10.11606/s1518-8787.20190530007052017-01-30T00:05:00Z2017-01-30T00:05:00ZMendonça, Raquel de DeusLopes, Mariana SouzaFreitas, Patrícia PinheiroCampos, Suellen FabianeMenezes, Mariana Carvalho deLopes, Aline Cristine Souza
<em>Mendonça, Raquel De Deus</em>;
<em>Lopes, Mariana Souza</em>;
<em>Freitas, Patrícia Pinheiro</em>;
<em>Campos, Suellen Fabiane</em>;
<em>Menezes, Mariana Carvalho De</em>;
<em>Lopes, Aline Cristine Souza</em>;
<br/><br/>
ABSTRACT OBJECTIVE To analyze the quantity and diversity in the consumption fruits and vegetables, as well as its relationship with the consumer’s purchase characteristics and food environment. METHODS Baseline study stemming from a controlled and randomized community trial investigating a sample representative of Primary Health Care services (Health Academy Program) of Belo Horizonte, state of Minas Gerais. The intake of fruits and vegetables was analyzed in servings/day, whereas diversity was assessed by the Food Frequency Questionnaire. Users were also questioned on the frequency, purchase location and availability of these foods at their households. To assess the consumer’s food environment, commercial establishments within a 1.6 km radius around the program unit sampled were audited. RESULTS 3,414 adults and older adults (88.1% women) were investigated, as well as 336 commercial establishments, in 18 units of the Health Academy Program. The average consumption of fruits and vegetables was adequate [5.4 (SD = 2.1) servings/day] but monotonous, with average daily intake of two different types. In the establishments audited, a good diversity (77.7% and 85.0%) and variety (74.5% and 81.4%) of fruits and vegetables was observed, although with lower quality of vegetables (60.4%). After adjusting for sociodemographic variables, we identified that knowledge on food crops (p = 0.006), increased monthly availability of fruits at households (p < 0.001), and greater variety of fruits (p = 0.03) and quality of vegetables (p = 0.05) in commercial establishments could improve the quantitative intake of fruits and vegetables, whereas a greater variety of fruits (p = 0.008) would increase consumption diversity. CONCLUSIONS The intake of fruits and vegetables was quantitatively adequate but monotonous, being influences by the consumer environment. Such results highlight the need for improving educational actions in health services and programs, in addition to acting on the consumer environment, aiming to promote and maintain the adequate and diversified consumption, as recommended by Brazilian guidelines for proper and healthy eating.Hospital-acquired conditions and length of stay in the pregnancy and puerperal cycle10.11606/s1518-8787.20190530006882017-01-30T00:05:00Z2017-01-30T00:05:00ZSilva, Thales Philipe Rodrigues daCarmo, Ariene Silva doNovaes, Taiane GonçalvesMendes, Larissa LouresMoreira, Alexandra DiasPessoa, Milene CristineCosenza, LunaPereira, Juliana Fantini ChavesMatozinhos, Fernanda Penido
<em>Silva, Thales Philipe Rodrigues Da</em>;
<em>Carmo, Ariene Silva Do</em>;
<em>Novaes, Taiane Gonçalves</em>;
<em>Mendes, Larissa Loures</em>;
<em>Moreira, Alexandra Dias</em>;
<em>Pessoa, Milene Cristine</em>;
<em>Cosenza, Luna</em>;
<em>Pereira, Juliana Fantini Chaves</em>;
<em>Matozinhos, Fernanda Penido</em>;
<br/><br/>
ABSTRACT OBJECTIVE To analyze the impact of the Hospital-Acquired Conditions (HAC) in women in the puerperal and pregnancy cycle during length of stay. METHODS This cross-sectional study was conducted with 113,456 women, between July 2012 and July 2017, in Brazil’s national hospitals of the supplementary healthcare networks and philanthropists accredited to the Unified Health System (SUS). Data on hospital discharges were collected using the Diagnosis-Related Groups (DRG Brasil®) system. All DRGs of the major diagnostic category 14 (MDC14), including pregnancy, childbirth and puerperium, were included. The impact of HAC on length of stay was estimated by Student’s t-test, and the effect size by Cohen’s d, which allows to assess clinical relevance. RESULTS The most prevalent diagnostic categories related to MDC14 were vaginal and cesarean deliveries without complicating diagnoses, both at institutions accredited to SUS and those for supplementary health care. The prevalence of HAC was 3.8% in supplementary health and 2.5% in SUS. Hospitals providing services to supplementary health care providers had a longer length of stay considering HAC for patients classified as DRG: cesarean section with complications or comorbidities at admission (p < 0.001; Cohen’s d = 0.74), cesarean section without complications or comorbidities at admission (p < 0.001, Cohen’s d = 0.31), postpartum and post abortion without listed procedure (p < 0.001, Cohen’s d = 1.05), and other antepartum diagnoses with medical complications (p < 0.001; Cohen’s d = 0.77). CONCLUSIONS This study showed that the prevalence of HAC was low both in the institutions accredited to attend by SUS and in those of supplementary health; however, its presence contributes to increasing the length of stay in cases of cesarean sections without complications or comorbidities in supplementary health institutions.Maternal characteristics and type of prenatal care associated with peregrination before childbirth10.11606/s1518-8787.20190530010872017-01-30T00:05:00Z2017-01-30T00:05:00ZMendes, Rosemar BarbosaSantos, José Marcos de JesusPrado, Daniela SiqueiraGurgel, Rosana QueirozBezerra, Felipa DaianaGurgel, Ricardo Queiroz
<em>Mendes, Rosemar Barbosa</em>;
<em>Santos, José Marcos De Jesus</em>;
<em>Prado, Daniela Siqueira</em>;
<em>Gurgel, Rosana Queiroz</em>;
<em>Bezerra, Felipa Daiana</em>;
<em>Gurgel, Ricardo Queiroz</em>;
<br/><br/>
ABSTRACT OBJECTIVE To analyze the maternal characteristics and type of prenatal care associated with peregrination before childbirth among pregnant women in a northeastern Brazilian state. METHODS Quantitative and transversal study, with descriptive and analytical approaches, part of the Nascer em Sergipe research held between June 2015 and April 2016. A total of 768 puerperal women proportionally distributed across all maternities of the state (n = 11) were evaluated. Data were collected in interviews and from prenatal records. The associations between antepartum peregrination and the exposure variables were described in absolute and relative frequencies, crude and adjusted odds ratios and their respective confidence intervals. RESULTS Antepartum peregrination was reported by 29.4% (n = 226) of the interviewees, most of whom sought care in a single service before the current one (87.6%; n = 198). It should be noted that antepartum peregrination was less frequent among women aged ≥ 20 years old (OR = 0.50; 95%CI 0.34–0.71), with high education level (OR = 0.42; 95%CI 0.31–0.59) and a paid job (adjusted OR = 0.59; 95%CI 0.41–0.82), who had been instructed during prenatal care about the referral maternity for childbirth (adjusted OR = 0.88; 95%CI 0.42–0.92), and who used the private service to receive prenatal (adjusted OR = 0.44; 95%CI 0.18–0.86) or childbirth (adjusted OR = 0.96; 95%CI 0.66–0.98) care. No statistical evidence of associations between gestational characteristics and the occurrence of peregrination was observed. CONCLUSIONS Antepartum peregrination suffers interference from the mother’s socioeconomic characteristics, the type of prenatal care received and the source of funding for childbirth.Restrictive measure for the commercialization of antimicrobials in Brazil: results achieved10.11606/s1518-8787.20190530008792017-01-30T00:05:00Z2017-01-30T00:05:00ZCosta, Josiane Moreira daMoura, Cristiano Soares dePádua, Cristiane Aparecida Menezes deVegi, Aline Siqueira FogalMagalhães, Sérgia Maria StarlingRodrigues, Marina BarraRibeiro, Andréia Queiroz
<em>Costa, Josiane Moreira Da</em>;
<em>Moura, Cristiano Soares De</em>;
<em>Pádua, Cristiane Aparecida Menezes De</em>;
<em>Vegi, Aline Siqueira Fogal</em>;
<em>Magalhães, Sérgia Maria Starling</em>;
<em>Rodrigues, Marina Barra</em>;
<em>Ribeiro, Andréia Queiroz</em>;
<br/><br/>
ABSTRACT OBJECTIVE To assess whether the incidence of hospital infection by a resistant microorganism decreased after the implementation of the restrictive measure of the National Health Surveillance Agency for the commercialization of antimicrobials. METHODS A historical cohort study of medical records of adult patients admitted to a general and public hospital from May 2010 to July 2011. A cohort was formed with patients admitted in the period before the restrictive measure for the commercialization of antimicrobials (Phase I) and a second cohort was formed with patients admitted after the implementation of the restrictive measure (Phase II). RESULTS The instantaneous risk of hospital infection by a resistant microorganism was estimated at seven by 1,000 people-time (95%CI 0.006–0.008) in Phase I, and four by 1,000 people-time (95%CI 0.003–0.005) in Phase II of the study. The differences between the survival curves in the different phases of the study and stratified by age group were also significant (p < 0.05). CONCLUSIONS The results suggest that the implementation of the restrictive measure of the commercialization of antimicrobials by the National Health Surveillance Agency reduced the incidence of hospital infection by a resistant microorganism.Cost-effectiveness of implant-supported dental prosthesis compared to conventional dental prosthesis10.11606/s1518-8787.20190530010662017-01-30T00:05:00Z2017-01-30T00:05:00ZProbst, Livia FernandesVanni, TazioCavalcante, Denise de Fátima BarrosSilva, Erica Tatiane daCavalcanti, Yuri WanderleyPasseri, Luis AugustoPereira, Antonio Carlos
<em>Probst, Livia Fernandes</em>;
<em>Vanni, Tazio</em>;
<em>Cavalcante, Denise De Fátima Barros</em>;
<em>Silva, Erica Tatiane Da</em>;
<em>Cavalcanti, Yuri Wanderley</em>;
<em>Passeri, Luis Augusto</em>;
<em>Pereira, Antonio Carlos</em>;
<br/><br/>
ABSTRACT OBJECTIVE To conduct a cost-effectiveness analysis of alternatives for rehabilitation treatment of mandibular edentulism in the context of the Brazilian Unified Health System (implant-supported total dental prosthesis versus conventional total dental prosthesis). METHODS A Markov model was developed to capture long-term clinical and economic outcomes. The model’s population was comprised of a hypothetical cohort of 1,000,000 patients, aged 55 years, with total mandibular edentulism and without medical contraindications for performing surgical procedures. The adopted analysis perspective was that of the Brazilian Unified Health System. Based on the proposed model, we calculated cost – in BRL, and effectiveness – measured by quality-adjusted prosthesis year (QAPY). The time horizon of the analysis was 20 years. RESULTS Considering a 5% discount in costs and effects, the incremental cost-effectiveness ratio of implant-supported total dental prostheses compared to conventional total dental prosthesis (BRL 464.22/QAPY) was lower than the willingness to pay threshold adopted in the model (BRL 3,050.00/QAPY). CONCLUSIONS The results of this economic analysis showed that the rehabilitation of mandibular edentulous patients by implant-supported total prosthesis is very cost-effective when compared to conventional complete prosthesis, considering the cost-effectiveness limits employed.Adapted version of the Pubertal Development Scale for use in Brazil10.11606/s1518-8787.20190530009152017-01-30T00:05:00Z2017-01-30T00:05:00ZPompéia, SabineZanini, Gislaine de Almeida ValverdeFreitas, Rafaella Sales deInacio, Luanna Maristella CabanalSilva, Flávia Calanca daSouza, Giovana Ribeiro deVitalle, Maria Sylvia de SouzaNiskier, Sheila RejaneCogo-Moreira, Hugo
<em>Pompéia, Sabine</em>;
<em>Zanini, Gislaine De Almeida Valverde</em>;
<em>Freitas, Rafaella Sales De</em>;
<em>Inacio, Luanna Maristella Cabanal</em>;
<em>Silva, Flávia Calanca Da</em>;
<em>Souza, Giovana Ribeiro De</em>;
<em>Vitalle, Maria Sylvia De Souza</em>;
<em>Niskier, Sheila Rejane</em>;
<em>Cogo-Moreira, Hugo</em>;
<br/><br/>
ABSTRACT OBJECTIVE To determine whether scores in an adapted version of the self-assessment Pubertal Development Scale into Portuguese match those from the gold standard in pubertal development (Tanner scale). METHODS This was a cross-sectional study with a convenience sample of 133 children and adolescents aged nine to 17 years (59 males; mean age of 13 years and six months, with standard deviation = 25 months). Youngsters completed the Pubertal Development Scale and were then examined by specialists in adolescent medicine. RESULTS Exact absolute agreement of pubertal stages were modest, but significant associations between measures (correlation; intra-class correlation coefficients of consistency) showed that the Pubertal Development Scale adequately measures changes that map onto pubertal development determined by physical examination, on par with international publications. Furthermore, scores obtained from each Pubertal Development Scale question reflected adequate gonadal and adrenal events assessed by clinical ratings, mostly with medium/high effect sizes. Latent factors obtained from scores on all Pubertal Development Scale questions had excellent fit indices in Confirmatory Factor Analyses and correlated with Tanner staging. CONCLUSIONS We conclude that self-assessment of body changes by youngsters using the Portuguese version of the Pubertal Development Scale is useful when estimates of pubertal progression are sufficient, and exact agreement with clinical staging is not necessary. The Pubertal Development Scale is, therefore, a reliable instrument for use in large-scale studies in Brazil that aim at investigating adolescent health related to pubertal developmental. The translated version and scoring systems are provided.Real-life challenge: training program on drug use and adolescence in primary health care10.11606/s1518-8787.20190530011252017-01-30T00:05:00Z2017-01-30T00:05:00ZPereira, Bruna Antunes de Aguiar XimenesAzevedo, Renata Cruz Soares de
<em>Pereira, Bruna Antunes De Aguiar Ximenes</em>;
<em>Azevedo, Renata Cruz Soares De</em>;
<br/><br/>
ABSTRACT Guidelines emphasize the importance of approaching substance use by adolescents, particularly in primary health care. However, there are problems with its incorporation. The objective of this study was to present the training stages on the theme for professionals in primary health care. Researchers conducted logistic structuring, content elaboration and evaluation of difficulties before and after training. Sixty percent of professionals involved in the care of adolescents in a medium-sized city participated in the study. More than half of them stated having difficulties in the approach, mainly theoretical limitations and short consultations. After the training, the professionals informed whether they felt more prepared, but practical difficulties remained.Seasonal variation of femoral fractures in the state of São Paulo, Southeast Brazil10.11606/s1518-8787.20190530010512017-01-30T00:05:00Z2017-01-30T00:05:00ZSouza, Mônica Marin deSouza, Eniuce Menezes deNunes, Altacílio AparecidoMartinez, Edson Zangiacomi
<em>Souza, Mônica Marin De</em>;
<em>Souza, Eniuce Menezes De</em>;
<em>Nunes, Altacílio Aparecido</em>;
<em>Martinez, Edson Zangiacomi</em>;
<br/><br/>
ABSTRACT OBJECTIVE To examine the effect of seasonality on femoral fracture incidence among people residing in the state of São Paulo, Brazil. METHODS Ecological study based on a consecutive series of 216,348 reports of hospital admissions caused by femoral fractures. A Bayesian statistical model was used for time series analysis, considering the monthly average number of events of femoral fractures per day as a dependent variable. RESULTS Among the female population, significant seasonal effects were observed only for older women, aged 60 years or more. Among younger men (aged less than 20 years) there is not a clear seasonal effect, but among the other age groups there seems to exist a higher number of cases of femoral fractures during the coldest months of the year. CONCLUSIONS In general, more cases of fractures occur during the coldest months of the year; however, men and women have different patterns of incidence according to each age group.Psychometric properties of BREALD-30 for assessing adolescents’ oral health literacy10.11606/s1518-8787.20190530009992017-01-30T00:05:00Z2017-01-30T00:05:00ZLima, Larissa Chaves Morais deNeves, Érick Tássio BarbosaDutra, Laio da CostaFirmino, Ramon TarginoAraújo, Luiza Jordânia Serafim dePaiva, Saul MartinsFerreira, Fernanda MoraisGranville-Garcia, Ana Flávia
<em>Lima, Larissa Chaves Morais De</em>;
<em>Neves, Érick Tássio Barbosa</em>;
<em>Dutra, Laio Da Costa</em>;
<em>Firmino, Ramon Targino</em>;
<em>Araújo, Luiza Jordânia Serafim De</em>;
<em>Paiva, Saul Martins</em>;
<em>Ferreira, Fernanda Morais</em>;
<em>Granville-Garcia, Ana Flávia</em>;
<br/><br/>
ABSTRACT OBJECTIVE To evaluate the psychometric properties of the Brazilian Portuguese version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) administered to adolescents. METHODS The study included 750 adolescents: 375 aged 12 years and 375 aged 15–19 years, attending public and private schools in Campina Grande, state of Paraíba, Brazil, in 2017. Reliability was measured based on internal consistency and test-retest reliability. Convergent validity was measured based on correlations between BREALD-30 and Functional Literacy Indicator scores. Divergent validity was measured by comparing BREALD-30 scores with sociodemographic variables. For predictive validity, the association between BREALD-30 scores and the presence of cavitated carious lesions was tested using a multiple logistic regression model. All statistical tests were performed with a significance level of 5%. RESULTS BREALD-30 showed good internal consistency for the 12 year olds and 15 to19 year olds (Cronbach’s alpha = 0.871 and 0.834, respectively) and good test-retest reliability [intraclass correlation coefficient (ICC) = 0.898 and 0.974; kappa = 0.804 and 0.808, respectively]. Moreover, item-total correlation was satisfactory for all items. BREALD-30 had convergent validity with the Functional Literacy Indicator for 12 year olds (rs = 0.558, p < 0.001) and for 15 to 19 year olds (rs = 0.652, p < 0.001). Participants with higher oral health literacy levels who attended private schools (p < 0.001), belonged to economic classes A and B2 (p < 0.001), and who had parents with higher education levels (p < 0.001) were included, indicating the divergent validity of the BREALD-30. Participants with lower BREALD-30 scores were more likely to have cavitated carious lesions [12 year olds: odds ratio (OR) = 2.37; 95% confidence interval (95%CI): 1.48–3.80; 15 to 19 year olds: OR = 1.96; 95%CI 1.24–3.11]. CONCLUSIONS BREALD-30 shows satisfactory psychometric properties for use on Brazilian adolescents and can be applied as a fast, simple, and reliable measure of oral health literacy.Trend analysis of leprosy indicators in a hyperendemic Brazilian state, 2001–201510.11606/s1518-8787.20190530007522017-01-30T00:05:00Z2017-01-30T00:05:00ZAnchieta, Jefferson de Jesus SilvaCosta, Léa Márcia Melo daCampos, Leonardo CostaVieira, Maurício dos RemédiosMota, Osvaldina SilvaMorais Neto, Otaliba LibânioSouza, Marta Rovery deGuimarães, Rafael Alves
<em>Anchieta, Jefferson De Jesus Silva</em>;
<em>Costa, Léa Márcia Melo Da</em>;
<em>Campos, Leonardo Costa</em>;
<em>Vieira, Maurício Dos Remédios</em>;
<em>Mota, Osvaldina Silva</em>;
<em>Morais Neto, Otaliba Libânio</em>;
<em>Souza, Marta Rovery De</em>;
<em>Guimarães, Rafael Alves</em>;
<br/><br/>
ABSTRACT OBJECTIVE To analyze the temporal trend of leprosy indicators in a hyperendemic state of Brazil, from 2001–2015. METHODS This is a time-series study of leprosy indicators in the state of Maranhão, Northeastern region of Brazil. The study used data from the Brazilian National System of Reportable Diseases, for the period between 2001 and 2015. The following indicators were evaluated: (i) detection coefficient in the general population; (ii) detection coefficient in people under 15 years old; (iii) rate of cases with grade 2 physical disability in the diagnosis; (iv) rate of examined contacts, and (v) proportion of healing . The Prais-Winsten regression model was used for trend analysis. Analyses were performed for the state and by each health region. RESULTS 77,697 leprosy cases were analyzed in the general population and 7,599 in individuals under 15 years old. The detection coefficient in the general population ranged from 80.7/100 thousand inhabitants in 2001 to 51.2/100 thousand inhabitants in 2015. The coefficient in the general population presented a downward trend (annual percentage variation [APV] = -2.98; 95%CI -4.15– -1.79). For the population under 15 years old, the rate was 24.9/100 thousand inhabitants in 2001, and 19.9/100 thousand inhabitants in 2015, with downward trend (APV = -3.07; 95%CI -4.95– -1.15). It was observed upward trend in rate of contacts examined (APV = 2.35; 95%CI 0.58–4.15) and rate of cases with grade 2 disability (APV = 2.19; 95%CI 0.23–4.19). Stationary trend was observed in the proportion of healing (APV = -0.10; 95%CI -0.50–0.30). Regional differences were found in the performance of the indicators. CONCLUSIONS A downward trend for the detection coefficients in the general population and in individuals under 15 years old was found in Maranhão. Despite this result, the rates are still very high, demanding efforts from all spheres of public administration and health professionals to reduce the burden of the disease in the state.Gestational weight gain, nutritional status and blood pressure in pregnant women10.11606/s1518-8787.20190530008802017-01-30T00:05:00Z2017-01-30T00:05:00ZCampos, Chiara Alzineth SilvaMalta, Maira BarretoNeves, Paulo Augusto RibeiroLourenço, Bárbara HatzlhofferCastro, Marcia CCardoso, Marly Augusto
<em>Campos, Chiara Alzineth Silva</em>;
<em>Malta, Maira Barreto</em>;
<em>Neves, Paulo Augusto Ribeiro</em>;
<em>Lourenço, Bárbara Hatzlhoffer</em>;
<em>Castro, Marcia C</em>;
<em>Cardoso, Marly Augusto</em>;
<br/><br/>
ABSTRACT OBJECTIVE To evaluate whether weekly gestational weight gain is associated with anemia, vitamin A insufficiency, and blood pressure levels in the third trimester of pregnancy. METHODS A prospective study with 457 pregnant women attending primary care in Cruzeiro do Sul, Acre. The weekly gestational weight gain rate measured between the second and third trimesters was classified as insufficient, adequate, and excessive according to the recommendations of the Institute of Medicine 2009. The outcomes at the beginning of the third gestational trimester were: anemia (Hb < 110 g/L), vitamin A insufficiency (serum retinol<1.05 μmol/L) and blood pressure levels (continuous values, in mmHg). Age-adjusted prevalence ratios, schooling, and use of vitamin and mineral supplements were calculated in Poisson regression models with robust variance. RESULTS A total of 18.6% of pregnant women had insufficient weekly weight gain, and 59.1% had excessive weight gain. The frequencies of anemia, vitamin A insufficiency and hypertension (systolic blood pressure ≥ 140 mmHg or diastolic ≥ 90 mmHg) were 17.5%, 13.4%, and 0.6%, respectively. The prevalence ratios for anemia among pregnant women with insufficient and excessive weight gain were 0.41 (95%CI 0.18–0.93) and 1.00 (95%CI 0.63–1.59), respectively, when compared to pregnant women with adequate weight gain. For vitamin A insufficiency, the adjusted prevalence ratio was significantly higher among pregnant women with insufficient weight gain (2.85, 95%CI 1.55–5.24) and no difference for excessive weight gain (1.53, 95%CI 0.84–2.74) when compared to pregnant women with adequate weight gain. Pregnant women with excessive weight gain had higher mean systolic blood pressure (111.10; 95%CI 109.9–112.2) when compared to pregnant women with insufficient weight gain (107.50; 95%CI 105.4–109.6) and adequate (106.20; 95%CI 104.3–108.20). CONCLUSIONS Insufficient weekly gestational weight gain was associated with the risk of vitamin A insufficiency. Excessive weight gain, in turn, was associated with higher blood pressure values at the beginning of the third gestational trimester.Ordinance 3992/2017: challenges and advances for resource management in the Brazilian Unified Health System (SUS)10.11606/s1518-8787.20190530010522017-01-30T00:05:00Z2017-01-30T00:05:00ZPereira, Blenda Leite SaturninoOliveira Junior, Antonio Carlos Rosa deFaleiros, Daniel Resende
<em>Pereira, Blenda Leite Saturnino</em>;
<em>Oliveira Junior, Antonio Carlos Rosa De</em>;
<em>Faleiros, Daniel Resende</em>;
<br/><br/>
ABSTRACT To advance in order to overcome the challenge of enabling greater autonomy in the use of financial resources in the Unified Health System (SUS), system managers agreed that transfers from the Union to other federated entities will be carried out through a financial investment account and a costing account. Over the past few years, states and municipalities managed more than 34,000 bank accounts dedicated to the Union’s on-lendings, in which balance exceeded R$8 billion. However, from 2018, Ordinance 3,992/2017 unequivocally separated the budget flow from the financial flow, and the fund-to-fund transfers started to be carried out in only 11,190 bank accounts. Since then, managers have had financial autonomy in the management of financial resources received from the Union, if in accordance with the parameters established in their respective budget items at the end of each fiscal year.Spatial analysis of pneumococcal meningitis in São Paulo in the pre- and post-immunization era10.11606/s1518-8787.20190530011832017-01-30T00:05:00Z2017-01-30T00:05:00ZOliveira, Danise SennaChiaravalloti Neto, FranciscoMota, Thiago SantosAraujo, Daniel Brito deSartori, Ana Marli Christovam
<em>Oliveira, Danise Senna</em>;
<em>Chiaravalloti Neto, Francisco</em>;
<em>Mota, Thiago Santos</em>;
<em>Araujo, Daniel Brito De</em>;
<em>Sartori, Ana Marli Christovam</em>;
<br/><br/>
ABSTRACT OBJECTIVE To analyze the pneumococcal meningitis incidence rates in the State of São Paulo, Brazil, by age group, municipalities and micro-regions, as well as the spatial distribution of pneumococcal meningitis incidence rates among children under 5 years old in the pre- (2005–2009) and post-vaccination (2011–2013) periods and its associations with socioeconomic variables and vaccination coverage. METHODS The data source was the Brazilian Notifiable Diseases Information System. For the pre- and post-vaccination periods, thematic maps were built for pneumococcal meningitis incidence in under-5 children, by São Paulo state micro-regions, vaccination coverage and socioeconomic variables, using QGIS 2.6.1 software. Scan statistics performed by the SatScan 9.2 software were used to analyze spatial and spatiotemporal clusters in São Paulo municipalities and micro-regions. A Bayesian inference for latent Gaussian model with zero-inflated Poisson model through the integrated nested Laplace approximation was used in the spatial analysis to evaluate associations between pneumococcal meningitis incidence rates and socioeconomic variables of interest in São Paulo micro-regions. RESULTS From 2005 to 2013, 3,963 pneumococcal meningitis cases were reported in São Paulo. Under-5 children were the most affected in the whole period. In the post-vaccination period, pneumococcal meningitis incidence rates decreased among this population, particularly among infants (from 4.17/100,000 in 2005 to 2.54/100,000 in 2013). Two clusters were found in pre-vaccination – one of low risk for pneumococcal meningitis, in the northwest of the state (OR = 0.45, p = 0.0003); and another of high risk in the southeast (OR = 1.62, p = 0.0000). In the post-vaccination period, only a high-risk cluster remained, in the southeast (RR = 1.97, p = 0.0570). In Bayesian analysis, wealth was the only variable positively associated to pneumococcal meningitis (RR = 1.026, 95%CI 1.002–1.052). CONCLUSIONS Pneumococcal meningitis is probably underdiagnosed and underreported in São Paulo. Differentiated rates of pneumococcal meningitis diagnosis and reporting in each microregion, according to the São Paulo Index of Social Responsibility, might explain our results.Cultural adaptation of the Retirement Resources Inventory for Brazilian culture10.11606/s1518-8787.20190530008632017-01-30T00:05:00Z2017-01-30T00:05:00ZGvozd, RaquelRossaneis, Mariana AngelaPissinati, Paloma de Souza CavalcanteGuirardello, Edinêis de BritoHaddad, Maria do Carmo Fernandez Lourenço
<em>Gvozd, Raquel</em>;
<em>Rossaneis, Mariana Angela</em>;
<em>Pissinati, Paloma De Souza Cavalcante</em>;
<em>Guirardello, Edinêis De Brito</em>;
<em>Haddad, Maria Do Carmo Fernandez Lourenço</em>;
<br/><br/>
ABSTRACT OBJECTIVE To translate and adapt the Retirement Resources Inventory for Brazilian culture. METHODS Methodological research including the stages of translation, synthesis, evaluation by committee of judges, back-translation and pre-test. The internal consistency of the instrument with Cronbach’s alpha coefficient was evaluated. RESULTS We considered the stages of translation and cultural adaptation adequate. The evaluation of the synthesis version by the judges resulted in the need to change 95.0% of the items to ensure the semantic, idiomatic, cultural and conceptual equivalence between the original and translated versions. In general consensus of the instrument, the agreement rate among the judges for the equivalences was 84.4%. As for the pre-test stage, 25 pre-retirees participated. The participants suggested adjustments in the instrument. The instrument’s internal consistency was 0.85. The mean time to fill in the instrument was 18.7 minutes CONCLUSIONS The methodological process of cultural adaptation of the Retirement Resources Inventory resulted in adequate content validity and ease of understanding by the participants. We emphasize that this study precedes the evaluation process of the psychometric properties of the instrument, which will be carried out in new studies.Dietary patterns of pregnant women, maternal excessive body weight and gestational diabetes10.11606/s1518-8787.20190530009092017-01-30T00:05:00Z2017-01-30T00:05:00ZZuccolotto, Daniela Cristina CandelasCrivellenti, Lívia CastroFranco, Laércio JoelSartorelli, Daniela Saes
<em>Zuccolotto, Daniela Cristina Candelas</em>;
<em>Crivellenti, Lívia Castro</em>;
<em>Franco, Laércio Joel</em>;
<em>Sartorelli, Daniela Saes</em>;
<br/><br/>
ABSTRACT OBJECTIVE To investigate the relationship between the dietary patterns of pregnant women with maternal excessive body weight and gestational diabetes mellitus. METHODS A cross-sectional study conducted with a convenience sample of 785 adult pregnant women attended by the Unified Health System of Ribeirão Preto, state of São Paulo, between 2011 and 2012. Two 24-hour dietary recalls, corrected by the multiple source method, were employed . For the classification of the body mass index and the diagnosis of gestational diabetes mellitus, the criteria by Atalah and the World Health Organization were used, respectively. Dietary patterns were obtained by principal component analysis using the Varimax rotation method. The relationship between adherence to patterns, overweight and obesity was analyzed by multinomial logistic regression models and the relationship with gestational diabetes mellitus by adjusted unconditional logistic regression models. RESULTS We identified four dietary patterns: “traditional Brazilian”; “snacks”; “coffee” and “healthy”. Women with a higher adherence to the “Healthy” (OR = 0.52; 95%CI 0.33–0.83) and “Brazilian Traditional” patterns (OR = 0.61; 95%CI 0.38–0.96) presented a lower chance of obesity, when compared to women with lower adherence, regardless of confounding factors. After adjustment for maternal excessive body weight, there was no association between dietary patterns and gestational diabetes mellitus. CONCLUSIONS Among the pregnant women, greater adherence to “traditional Brazilian” and “healthy” patterns was inversely associated with obesity, but no relationship was identified with gestational diabetes mellitus after adjusting for excessive body weight. Prospective studies are recommended to investigate the relationship between dietary patterns, overweight and gestational diabetes mellitus, reducing the chance of reverse causality.Drug use in delivery hospitalization: Pelotas births cohort, 201510.11606/s1518-8787.20190530009132017-01-30T00:05:00Z2017-01-30T00:05:00ZSilveira, Marysabel Pinto TelisMiranda, Vanessa Iribarrem AvenaSilveira, Mariângela Freitas daPizzol, Tatiane da Silva DalMengue, Sotero SerrateBertoldi, Andréa Dâmaso
<em>Silveira, Marysabel Pinto Telis</em>;
<em>Miranda, Vanessa Iribarrem Avena</em>;
<em>Silveira, Mariângela Freitas Da</em>;
<em>Pizzol, Tatiane Da Silva Dal</em>;
<em>Mengue, Sotero Serrate</em>;
<em>Bertoldi, Andréa Dâmaso</em>;
<br/><br/>
ABSTRACT OBJECTIVE: Trace the pattern of drug use during delivery hospitalization. METHOD: Cross-sectional study carried out from June to October 2015, included in the 2015 Pelotas births cohort. All women living in the urban area of the city who were hospitalized for delivery were part of the sample. We collected information regarding drug prescription and drug use by mothers during the whole period of hospitalization. Sociodemographic data were obtained in interview after delivery, and other data were obtained from medical charts. The drugs were classified according to the Anatomical Therapeutic Chemical system. RESULTS: All study participants (1,392 women) used at least one drug, with the mean amount being larger the higher the age of the mother, both prepartum/during delivery and postpartum. It was also higher in cases of spinal anesthesia or general anesthesia, cesarean deliveries, school hospitals, and longer hospitalizations. Analysis of the sample as a whole showed no significant difference in the number of drugs used according to hospitalization type, but when stratified by length of hospital stay the mean was higher in SUS hospitalizations than in private and health insurance hospitalizations. Drugs for the nervous system were the most used (30.5%), followed by drugs for the alimentary tract and metabolism (13.8%). The use of anti-infective agents and drugs that act on the cardiovascular and respiratory systems was higher in mothers who underwent cesarean delivery. This study showed high drug consumption in the delivery hospitalization period, and showed cesarean delivery and epidural anesthesia as the main factors related to high drug consumption in this period. CONCLUSIONS: We found high drug consumption in the delivery hospitalization period, and the main factors were cesarean delivery and epidural anesthesia. Drugs that act on the nervous system were the most used.Equity analysis of resource distribution for the Popular Pharmacy Program10.11606/s1518-8787.20190530007312017-01-30T00:05:00Z2017-01-30T00:05:00ZSilva, Maria Eduarda de Lima eAlmeida, Aléssio Tony Cavalcanti deAraújo Júnior, Ignácio Tavares de
<em>Silva, Maria Eduarda De Lima E</em>;
<em>Almeida, Aléssio Tony Cavalcanti De</em>;
<em>Araújo Júnior, Ignácio Tavares De</em>;
<br/><br/>
ABSTRACT OBJECTIVE To analyze the regional allocation of the resources from the Brazilian Popular Pharmacy Program, taking into account the relative availability of the program and the potential needs of the region. METHODS Data from the National Health Survey of the Annual Report of Social Information and the administrative database of the program were used to create a non-parametric indicator of coverage using multiple data envelopment analysis technique. This indicator considers the relative availability of the program, taking into account equal access to equal needs (equity based on regional needs). The analysis of this indicator shows if the regions that most need pharmaceutical assistance are those that receive more resources from the Brazilian Popular Pharmacy Program. RESULTS The states belonging to the richest regions of the country, Southeast and South, present wider relative coverage of the Brazilian Popular Pharmacy Program compared to poorer localities. In addition, the inequalities observed between locations are better explained by inefficiency in the transfer of resources to the basic component of pharmaceutical care than by the Brazilian Popular Pharmacy Program itself. According to the model, a 43.76% increase in the transfer to the basic component of pharmaceutical care would be required in order to improve equity, whereas the increase required by the Brazilian Popular Pharmacy Program is equivalent to 22.71%. CONCLUSIONS Although the Brazilian Popular Pharmacy Program seeks to reduce the socioeconomic inequalities observed in access to pharmaceutical care, which integrates health care services, regional disparities in access to medicine persist. These regional differences are attributed mostly to allocation failures and problems in managing the conventional pharmaceutical care cycle provided through SUS pharmacies.Environmental and socioeconomic analysis of malaria transmission in the Brazilian Amazon, 2010–201510.11606/s1518-8787.20190530009832017-01-30T00:05:00Z2017-01-30T00:05:00ZCanelas, TiagoCastillo-Salgado, CarlosBaquero, Oswaldo SantosRibeiro, Helena
<em>Canelas, Tiago</em>;
<em>Castillo-Salgado, Carlos</em>;
<em>Baquero, Oswaldo Santos</em>;
<em>Ribeiro, Helena</em>;
<br/><br/>
ABSTRACT OBJECTIVE To analyze the environmental and socioeconomic risk factors of malaria transmission at municipality level, from 2010 to 2015, in the Brazilian Amazon. METHODS The municipalities were stratified into high, moderate, and low transmission based on the annual parasite incidence. A multinomial logistic regression that compared low with medium transmission and low with high transmission was performed. For each category, three models were analyzed: one only with socioeconomic risk factors (Gini index, illiteracy, number of mines and indigenous areas); a second with the environmental factors (forest coverage and length of the wet season); and a third with all covariates (full model). RESULTS The full model showed the best performance. The most important risks factors for high transmission were Gini index, length of the wet season and illiteracy, OR 2.06 (95%CI 1.19–3.56), 1.73 (95%CI 1.19–2.51) and 1.10 (95%CI 1.03–1.17), respectively. The medium transmission showed a weaker influence of the risk factors, being illiteracy, forest coverage and indigenous areas statistically significant but with marginal influence. CONCLUSIONS As a disease of poverty, the reduction in wealth inequalities and, therefore, health inequalities, could reduce the transmission considerably. Besides, environmental risk factors as length of the wet season should be considered in the planning, prevention and control. Municipality-level and fine-scale analysis should be done together to improve the knowledge of the local dynamics of transmission.Patient safety culture from the perspective of workers and primary health care teams10.11606/s1518-8787.20190530007882017-01-30T00:05:00Z2017-01-30T00:05:00ZRaimondi, Daiane CortêzBernal, Suelen Cristina ZandonadiMatsuda, Laura Misue
<em>Raimondi, Daiane Cortêz</em>;
<em>Bernal, Suelen Cristina Zandonadi</em>;
<em>Matsuda, Laura Misue</em>;
<br/><br/>
ABSTRACT OBJECTIVE Analyze if the patient safety culture among professionals in the primary health care differs among health care teams. METHODS Cross-sectional and quantitative study conducted in April and May 2017, in a city in Southern Brazil. A total of 144 professionals who responded to the questionnaire “Survey on Patient Safety Culture in Primary Health Care” participated in the study. Data were analyzed in the Statistical Analysis Software program and expressed in percentage of positive responses. The ethical principles established for research with human beings were applied. RESULTS Patient safety culture is positive among 50.81% of the professionals, and the dimensions “your health service” (63.39%) and “patient safety and quality” (61.22%) obtained the highest average of positive responses. Significant differences were found between the family health and oral health teams (α = 0.05 and p < 0.05), in the dimensions “patient safety” (p = 0.0274) and “work at the health service” (p = 0.0058). CONCLUSIONS We concluded that, although close to the average, patient safety culture among professionals in the Primary Health Care is positive and that there are differences in safety culture between family health and oral health teams in comparison with the primary health care teams.Prenatal care in Southern Brazil: coverage, trend and disparities10.11606/s1518-8787.20190530009682017-01-30T00:05:00Z2017-01-30T00:05:00ZSaavedra, Janaina SCesar, Juraci ALinhares, Angélica O
<em>Saavedra, Janaina S</em>;
<em>Cesar, Juraci A</em>;
<em>Linhares, Angélica O</em>;
<br/><br/>
ABSTRACT OBJECTIVE To estimate coverage, examine trend and assess the disparity reduction regarding household income during prenatal care between mothers living in Rio Grande, state of Rio Grande do Sul, in 2007, 2010, 2013 and 2016. METHODS This study included all recent mothers living in this municipality, between 1/1 and 12/31 of those years, who had a child weighing more than 500 grams or 20 weeks of gestational age in one of the only two local maternity hospitals. Trained interviewers applied, still in the hospital and up to 48 hours after delivery, a unique and standardized questionnaire, seeking to investigate maternal demographic and reproductive characteristics, the socioeconomic conditions of the family and the assistance received during pregnancy and childbirth. To assess the adequacy of prenatal care, the criteria proposed by Takeda were used, which considers only the number of prenatal appointments and gestational age at initiation, and by Silveira et al., who in addition to these two variables, considers the achievement of some laboratory tests. Chi-square tests were used to compare proportions and assess the linear trend. RESULTS The total of 10,669 recent mothers were included in this survey (96.8% of the total). Prenatal coverage substantially increased between 2007 and 2016. According to Takeda, it rose from 69% to 80%, while for Silveira et al., it increased from 21% to 55%. This improvement occurred for all income groups (p < 0.01). The disparity between the extreme categories of income reduced, according to Takeda, and increased according to Silveira et al. CONCLUSIONS The provision of prenatal care, considering only the number of appointments and the early start, occurred in greater proportion among the poorest. However, only the richest recent mothers were contemplated with more elaborate care, such as laboratory tests, which increased the disparities in the provision of prenatal care.Exploring the effect of time and sex in family and community violence from 2008 to 201410.11606/s1518-8787.20190530009102017-01-30T00:05:00Z2017-01-30T00:05:00ZBarbosa, Kevan Guilherme NóbregaRodrigues, Lorrany GabrielaAlencar, Gizelton PereiraD’avila, SérgioFerreira, Efigênia Ferreira eFerreira, Raquel Conceição
<em>Barbosa, Kevan Guilherme Nóbrega</em>;
<em>Rodrigues, Lorrany Gabriela</em>;
<em>Alencar, Gizelton Pereira</em>;
<em>D’avila, Sérgio</em>;
<em>Ferreira, Efigênia Ferreira E</em>;
<em>Ferreira, Raquel Conceição</em>;
<br/><br/>
ABSTRACT OBJECTIVE To evaluate the effect of the time and the sex of victims and perpetrators on the rates of family and community physical violence in a Brazilian municipality over seven years (2008–2014). METHODS We made a census analysis from non-fatal victims attended in the Forensic Institute of the Scientific Civil Police. The monthly and annual violence rates were calculated based on the population size of the municipality. Time series was evaluated by negative binomial regression models, based on the number of cases with population offset and considering the effect of the sex of victims and perpetrators. RESULTS A total of 3,324 cases of family and 4,634 cases of community violence were analyzed. There was a significant increase in family violence rates for female victims and male perpetrators. Family violence rates were always higher for female victims than for male and it was always lower for female perpetrators than for male (p < 0.001). There was a lower risk of community violence for male victims after 2013 and a decrease of aggression perpetrated by men over time. Men and women were similarly affected by community violence; however, the perpetrators were more frequently men. CONCLUSIONS The results indicate a trend of increasing female victims in the family violence, mainly perpetrated by men. The reduction in community violence rates could be the result of policies to reduce crime.Recommendations of physical activity and rest in a Colombian prenatal control program10.11606/s1518-8787.20190530009342017-01-30T00:05:00Z2017-01-30T00:05:00ZRuiz-Rodríguez, MyriamSánchez-Martínez, YuriRamírez-Muñoz, Paula CamilaCamargo-Lemos, Diana Marina
<em>Ruiz-Rodríguez, Myriam</em>;
<em>Sánchez-Martínez, Yuri</em>;
<em>Ramírez-Muñoz, Paula Camila</em>;
<em>Camargo-Lemos, Diana Marina</em>;
<br/><br/>
ABSTRACT OBJECTIVE To determine the frequency of the registry of physical activity and rest recommendations made to pregnant women and to explore their associated factors in a prenatal care program of primary care public institutions in Bucaramanga, Colombia. METHODS An observational study was conducted. The sampling frame consisted of the medical records of the pregnant women who attended at least one prenatal care program between January 1 and December 31, 2012 (n = 2.932), in 21 primary care health centers. We analyzed sociodemographic variables, prenatal and clinical antecedents, and information related to health personnel and the organization of health centers as possible factors associated with the recommendations of physical activity and rest recorded in the clinical history. Logistic regression models were applied to explore associations with α = 0.10. RESULTS There was a frequency of 26.1% of PA recommendations and 3.6% of rest recommendation on record, issued by nutrition (97.3%) and medical (86.7%) professionals, respectively. The factors associated with the registration of physical activity recommendations were: being nulliparous pregnant (OR = 1.7), attending more than four Prenatal Care Attention Programs (OR = 2.2), having high or medium obstetric risk in the first prenatal care program (OR = 0.6), and being attended in the western (OR = 0.5) and eastern (OR = 0.2) administrative areas health centers. CONCLUSIONS The low frequency of physical activity recommendations found in the records makes it necessary to reinforce the management strategies of health centers and strengthen the monitoring and accompaniment to comply with the care protocols. In addition, it is necessary to train health teams on the benefits of physical activity and their proper prescription, considering the multiple benefits derived from their practice on the maternal-fetal health.Sampling strategy of an epidemiological survey using a satellite image program10.11606/s1518-8787.20190530008342017-01-30T00:05:00Z2017-01-30T00:05:00ZFerreira, Ticiane de Góes MárioRocha, José Mariano daDavid, Silvia Cardoso deBoligon, JocianaCasarin, MaísaGrellmann, Alessandra PascotiniMarin, JaniceArdenghi, Thiago MachadoZanatta, Fabricio BatistinMoreira, Carlos Heitor Cunha
<em>Ferreira, Ticiane De Góes Mário</em>;
<em>Rocha, José Mariano Da</em>;
<em>David, Silvia Cardoso De</em>;
<em>Boligon, Jociana</em>;
<em>Casarin, Maísa</em>;
<em>Grellmann, Alessandra Pascotini</em>;
<em>Marin, Janice</em>;
<em>Ardenghi, Thiago Machado</em>;
<em>Zanatta, Fabricio Batistin</em>;
<em>Moreira, Carlos Heitor Cunha</em>;
<br/><br/>
ABSTRACT OBJECTIVE To describe the sampling strategy of an epidemiological survey with the aid of satellite images, including details of the multistage probability sampling process. METHODS A probability sample of individuals living in the rural area of Rosário do Sul, state of Rio Grande do Sul, Brazil, aged 15 years old or more, was evaluated. Participants answered questionnaires (medical history, sociodemographic characteristics, habits, alcohol use, quality of life, stress, rumination, and self-perceived periodontal diseases), and were subjected to clinical oral examinations as well as anthropometric measurements (blood pressure, height, weight, abdominal and waist circumferences). Oral evaluation comprehended a complete periodontal exam at six sites per tooth, including the following assessments: furcation involvement; dental abrasion; tooth decay, including the indexing of missing and filled surfaces; O’Brien index; gingival abrasion; oral cavity and lip lesions; complete periapical radiographic exam, and use of prostheses. Besides this oral clinical approach, subgingival plaque, crevicular gingival fluid, saliva, and blood samples were collected. Examiners were trained and calibrated during previous evaluations. A pilot study allowed the logistic of the performed exams to be adjusted as needed. RESULTS Among 1,087 eligible individuals, 688 were examined (63.3%). Age, sex, and skin color data were compared to data from the last demographic census (2010) of the Brazilian Institute of Geography and Statistics, which served to validate the sampling strategy. CONCLUSIONS The careful methods used in this study, in which satellite images were used in the delimitation of epidemiological areas, ensure the quality of the estimates obtained and allow for these estimates to be used in oral health surveillance and health policies improvements.Prenatal evaluation in primary care in Northeast Brazil: factors associated with its adequacy10.11606/s1518-8787.20190530010242017-01-30T00:05:00Z2017-01-30T00:05:00ZSilva, Esther Pereira daLeite, Antônio Flaudiano BemLima, Roberto TeixeiraOsório, Mônica Maria
<em>Silva, Esther Pereira Da</em>;
<em>Leite, Antônio Flaudiano Bem</em>;
<em>Lima, Roberto Teixeira</em>;
<em>Osório, Mônica Maria</em>;
<br/><br/>
ABSTRACT OBJECTIVE To characterize prenatal care and verify possible factors associated with its adequacy. METHODS This is a cross-sectional study based on interviews with health care professionals and consultations on official documents of women attending prenatal of the primary health care in the city of João Pessoa, capital of Paraíba, in the Northeast region of Brazil. Prenatal care was evaluated by an index with criteria referring to aspects of structure, process and outcome, denominated IPR/Prenatal. The multivariate logistic regression method revealed that demographic, socioeconomic, reproductive and maternal morbidity variables were possible determinants for prenatal adequacy. RESULTS The survey involved 130 services and 1,625 primary health care patients. Prenatal care was adequate in approximately 23% of the cases. Low prevalence of referral to maternity, educational strategies and examinations were observed. The analysis showed that non-adolescent women (OR = 1,390), with a longer period of schooling (OR = 1.750), higher per capita income (OR = 1,870) and primiparous women (OR = 1,230) were more likely to have an adequate prenatal. CONCLUSIONS Prenatal care, when evaluated by broader criteria, showed a low percentage of adequacy. Strategies should be developed to ensure the referral to the maternity where the birth will take place and health education activities and examinations to provide adequate prenatal care in the municipality under study. In addition, factors associated with adequacy must be considered by managers and health professionals.Scheduling models and primary health care quality: a multilevel and cross-sectional study10.11606/s1518-8787.20190530009402017-01-30T00:05:00Z2017-01-30T00:05:00ZVidal, Tiago BarraRocha, Suelen AlvesHarzheim, ErnoHauser, LisianeTesser, Charles Dalcanale
<em>Vidal, Tiago Barra</em>;
<em>Rocha, Suelen Alves</em>;
<em>Harzheim, Erno</em>;
<em>Hauser, Lisiane</em>;
<em>Tesser, Charles Dalcanale</em>;
<br/><br/>
ABSTRACT OBJECTIVE To evaluate whether the scheduling model influences the perception of the user about the quality of primary health care centers. METHODS This is a cross-sectional and population-based study that measured the quality of centers by the Primary Care Assessment Tool (PCATool-Brazil), applied to adult users (n = 409) from 11 health centers in Florianópolis, state of Santa Catarina. Multilevel analysis was used to verify the relationship between the score of general quality of the primary health care and the scheduling model. The independent variables (age, skin color, scheduling model, panel size by primary health team, poverty ratio as income proxy, number of health teams, presence of economically interest areas, number of medical appointments in one year per primary health team, number of people treated in one year per health team), with p < 0.20 were selected for the multilevel model, which was adjusted with aggregates of information from users and health centers. RESULTS The health center that used advanced access had a general score of 7.04, while those using a weekly carve-out had a score of 6.26; the carve-out every 15 days, score of 5.87; and the traditional carve-out, score of 6.29. CONCLUSIONS The scheduling model of advanced access had a positive effect on the quality of primary health care, in the perception of users.Construction and validation of an instrument for the assessment of care provided to people with suicidal behavior10.11606/s1518-8787.20190530008882017-01-30T00:05:00Z2017-01-30T00:05:00ZLinhares, Laura Maria Souza deKawakame, Patrícia Moita GarciaTsuha, Daniel HenriqueSouza, Albert Schiaveto deBarbieri, Ana Rita
<em>Linhares, Laura Maria Souza De</em>;
<em>Kawakame, Patrícia Moita Garcia</em>;
<em>Tsuha, Daniel Henrique</em>;
<em>Souza, Albert Schiaveto De</em>;
<em>Barbieri, Ana Rita</em>;
<br/><br/>
ABSTRACT OBJECTIVE To develop and validate an instrument for evaluating primary health care professionals’ assistance to people with suicidal behavior. METHODS This was a methodological study, which began with a literature review, followed by the elaboration of an instrument. In its first version, the instrument had 34 items, divided into four domains: “professional characterization,” “professional perception ” “professional knowledge/abilities,” and “organization of the care network.” Contents were validated using the Delphi method. Semantic analysis was performed by college-educated primary health care professionals in greater and lesser strata of ability. For internal consistency analysis, Cronbach’s alpha coefficient was calculated. The study was conducted between January and December 2017. RESULTS After four Delphi rounds, the instrument was successfully validated. In its final form, it is comprised of 50 items, divided into five domains: “professional characterization,” “professional sensibility,” “professional experience,” “professional knowledge/abilities,” and “organization of the care network.” Questions belonging to the last four domains have answers on a five-point Likert scale. In the semantic analysis, 93.6% of the evaluations were “good” and “very good.” The instrument’s general Cronbach alpha was 0.90. CONCLUSIONS The final version of the instrument was able to fulfill its objectives. It is useful as a support for epidemiological research and planning of health actions. The evaluation of professional approaches to suicidal behavior is crucial for the organization of suicide assistance services in primary health care, and for the integration of services provided by different care units.Health system financing paradigm in the state of São Paulo: a regional analysis10.11606/s1518-8787.20190530007962017-01-30T00:05:00Z2017-01-30T00:05:00ZSoares, Adilson
<em>Soares, Adilson</em>;
<br/><br/>
ABSTRACT OBJECTIVE To analyze the allocation of financial resources in the Brazilian Unified Health System (SUS) in the state of São Paulo by level of care, health region, source of funds and level of government. METHODS This is an exploratory study based on 2014 data extracted from the Public Health Budget Database, presented in absolute terms, relative terms and per capita . RESULTS In 2014, R$52.1 bi were spent on public health, 58.0% having corresponded to the expenditures of the municipalities and 42.0% to those of the state government. Regional per capita spending varied from R$561.75 to R$824.85. As for the per capita spending on primary health care, which represented 37.5% of the municipalities’ total expenditure, the lowest value was found in the city of São Paulo and the highest, in Araçatuba. Campinas had the highest per capita expenditure on medium and high complexity care, while Presidente Prudente had the lowest. The highest regional percentage of the current net revenue spent on health was verified in Registro, and the lowest, in the city of São Paulo. CONCLUSIONS The paradigm of the health sector’s financing in São Paulo revealed that the expenditure on primary health care, level elected by health policy as strategic because it depends on coordination and integral health care in the attention networks, was not considered a priority in relation to the expenditure with the medium and high complexity, exposing the iniquities in the state’s regions.Ambulatory care sensitive conditions hospitalization for emergencies rates in Colombia10.11606/s1518-8787.20190530005632017-01-30T00:05:00Z2017-01-30T00:05:00ZGonzález-Vélez, Abel EMejía, Claudia Carolina ColmenaresPadilla, Eduardo LowMarín, Sandra Yadira MorenoBobadilla, Paola Andrea RengifoSánchez, Juan Pablo RuedaRuget, Mario Arturo Isaza
<em>González-Vélez, Abel E</em>;
<em>Mejía, Claudia Carolina Colmenares</em>;
<em>Padilla, Eduardo Low</em>;
<em>Marín, Sandra Yadira Moreno</em>;
<em>Bobadilla, Paola Andrea Rengifo</em>;
<em>Sánchez, Juan Pablo Rueda</em>;
<em>Ruget, Mario Arturo Isaza</em>;
<br/><br/>
ABSTRACT OBJECTIVE To analyze the emergency hospitalizations trend for ambulatory care sensitive conditions between 2011 and 2015 in a health insureance company of the Colombian Social Security General System. METHODS A log-linear analysis based on age-adjusted hospitalization rates for ambulatory care sensitive conditions in the Entidad Promotora de Salud Sanitas was used to estimate the annual percentage change in these rates and to identify joinponts of the rates. Data was collected from administrative sources. RESULTS There were 38,530 hospitalizations for ambulatory care sensitive conditions in 26,501 Entidad Promotora de Salud Sanitas enrollees, with a significant decrease in hospitalization rates. The annual percentage change estimated for the period was -9.5% with no significant joinpoints throughout the time interval. CONCLUSIONS A significant reduction in hospital admissions due to ambulatory care sensitive conditions in Entidad Promotora de Salud Sanitas enrollees were reported for the last five years in this study.Prevalence and factors associated to chronic kidney disease in older adults10.11606/s1518-8787.20190530007272017-01-30T00:05:00Z2017-01-30T00:05:00ZAmaral, Thatiana Lameira MacielAmaral, Cledir de AraújoVasconcellos, Maurício Teixeira Leite deMonteiro, Gina Torres Rego
<em>Amaral, Thatiana Lameira Maciel</em>;
<em>Amaral, Cledir De Araújo</em>;
<em>Vasconcellos, Maurício Teixeira Leite De</em>;
<em>Monteiro, Gina Torres Rego</em>;
<br/><br/>
ABSTRACT OBJECTIVE To verify the prevalence of chronic kidney disease and the factors associated to it in older adults (≥ 60 years). METHODS This is a population-based research conducted in 2014, involving 1,016 older adults living in urban and rural areas of the municipality of Rio Branco, Acre. Chronic kidney disease was defined by glomerular filtration rate < 60 ml/min/1.73 m 2 , estimated by the equations of the Chronic Kidney Disease Epidemiology Collaboration, and the presence of albuminuria > 29 mg/g. Association measure were estimated by gross and adjusted odds ratio (OR), with a confidence level of 95% (95%CI). RESULTS The overall prevalence of chronic kidney disease was 21.4% in older adults, with the associated factors age, diabetes (OR = 3.39; 95%CI 2.13–5.40), metabolic syndrome (OR = 2.49; 95%CI 1.71–3.63), self-assessment of poor health (OR = 1.79; 95%CI 1.10–2.91), arterial hypertension (OR = 1.82; 95%CI 1.04–3.19) and obesity (OR = 1.69; 95%CI 1.02–2.80). CONCLUSIONS The prevalence of chronic kidney disease was high in older adults, being associated with age, self-assessment of health as bad or very bad, obesity, diabetes and metabolic syndrome.Challenges and lessons from a primary care intervention in a Brazilian municipality10.11606/s1518-8787.20190530004572017-01-30T00:05:00Z2017-01-30T00:05:00ZAndrade, Mônica VNoronha, KenyaCardoso, Clareci SOliveira, Claudia D LCalazans, Júlia ASouza, Michelle N
<em>Andrade, Mônica V</em>;
<em>Noronha, Kenya</em>;
<em>Cardoso, Clareci S</em>;
<em>Oliveira, Claudia D L</em>;
<em>Calazans, Júlia A</em>;
<em>Souza, Michelle N</em>;
<br/><br/>
ABSTRACT OBJECTIVE To address the implementation of the Lab for Innovation in Chronic Conditions in Santo Antonio do Monte, indicating the main challenges and lessons of a new chronic condition model. METHODS This is an observational study based on two sources of data: 1) two cross-sectional household surveys, 2013 (2012 as reference year) and 2015 (2014 as reference year), representative for the entire population and four target groups (pregnant women; children under two years old; individuals with hypertension and diabetes); medical records of individuals who self-reported having hypertension or diabetes in the household survey of 2013. A descriptive statistics analysis was performed. RESULTS The main findings showed that the public health system is the main provider of health services, mainly primary care, in Santo Antonio do Monte. Besides, the implementation of Lab for Innovation in Chronic Conditions showed the importance of building a Primary Health Care network in small municipalities. CONCLUSIONS Community health agents and health managers played a fundamental role in the Primary Health Care network. The case study of Santo Antonio do Monte poses some challenges and lessons that clarify future interventions on building a Primary Health Care network that is essential to provide an adequate and longitudinal care to chronic conditions.Health Diplomacy and Global Health: Latin American perspectives10.11606/s1518-8787.20190530009362017-01-30T00:05:00Z2017-01-30T00:05:00ZRibeiro, HelenaVentura, Deisy de Freitas Lima
<em>Ribeiro, Helena</em>;
<em>Ventura, Deisy De Freitas Lima</em>;
<br/><br/>
ABSTRACT We will analyze and comment on the book Health Diplomacy and Global Health: Latin American Perspectives, edited by Paulo Marchiori Buss and Sebastián Tobar and published by Editora Fiocruz. Throughout its 653 pages, the book brings prominent national and foreign authors in the field of Health Diplomacy and Global Health, depicting a decade in which Brazil had great international protagonism in the field of Public Health, especially in South-South cooperation, in an innovative and structuring manner. Furthermore, the chapters present theoretical aspects and basic principles of Global Health as a new field of knowledge, in which the country has been developing and sharing scientific production with a Latin American perspective, focused on the pursuit of equity and health for all peoples of the world.Factors associated with environmental barriers of people with disabilities in Mexico10.11606/s1518-8787.20190530005562017-01-30T00:05:00Z2017-01-30T00:05:00ZGiraldo-Rodríguez, LilianaMino-León, DoloresMurillo-González, Juana CatalinaAgudelo-Botero, Marcela
<em>Giraldo-Rodríguez, Liliana</em>;
<em>Mino-León, Dolores</em>;
<em>Murillo-González, Juana Catalina</em>;
<em>Agudelo-Botero, Marcela</em>;
<br/><br/>
ABSTRACT OBJECTIVE: To examine the associations between sociodemographic, health and disability-related factors and the perception of environmental barriers outside the home environment by individuals with permanent disabilities in Mexico. METHODS: In this cross-sectional, population-based study, we used data from the 2010 National Survey of Perceptions of Disability in the Mexican Population of 2,041 participants older than 18 with permanent disability. The perceptions of barriers take into consideration the challenges of getting around and using transportation outside the home environment. The covariates consisted of sociodemographic, health-related and disability-related factors. Multivariate logistic regression was used. RESULTS: The perception of environmental barriers outside the home environment was associated with being a woman, living in an urban area, speaking an indigenous language, experiencing emotional symptoms, having walking/movement, visual or self-care disabilities, having severe/extreme disability, having disability caused by illness, using physical devices, and receiving assistance and care in the home environment. CONCLUSIONS: This information is valuable for the design of public policies and programs that promote the participation of individuals with permanent disabilities, a high-priority issue in low- and middle-income countries.Health Survey in a Peruvian health system (ENSSA): design, methodology and general results10.11606/s1518-8787.20190530011352017-01-30T00:05:00Z2017-01-30T00:05:00ZLlanos, Renán QuispeRamírez, Rofilia RamírezPalacios, Martha TizónFlores, Claudio FloresBorda-Olivas, AlfredoCastillo, Roger AraujoGuanira, JuanCondor, Risof SolisVillasante, Manuel CatacoraHurtado-Roca, Yamilée
<em>Llanos, Renán Quispe</em>;
<em>Ramírez, Rofilia Ramírez</em>;
<em>Palacios, Martha Tizón</em>;
<em>Flores, Claudio Flores</em>;
<em>Borda-Olivas, Alfredo</em>;
<em>Castillo, Roger Araujo</em>;
<em>Guanira, Juan</em>;
<em>Condor, Risof Solis</em>;
<em>Villasante, Manuel Catacora</em>;
<em>Hurtado-Roca, Yamilée</em>;
<br/><br/>
ABSTRACT OBJECTIVE To report the design, methodology and initial results of the National Socioeconomic Survey of Access to Health of the EsSalud Insured. RESULTS There were interviews in 25,000 homes, surveying 79,874 people, of which 62,659 were affiliated to EsSalud. The insured people are mainly males (50.6%) with a higher technical education level (39.7%). The insured population has mostly independent (95.0%) and own (68.1%) home. Only 34.5% of the insured practice some sport or physical exercise; 14.0% of the population suffers from a chronic disease; 3.5% have diabetes; and 7.1%, arterial hypertension. In the last three months, 35.4% of the members needed medical attention; of these, only 73.1% received health care and the remaining 10.9% were treated in pharmacies or non-formal health care services. RESULTS The 25,000 homes were interviewed, surveying 79,874 people, of which 62,659 were affiliated to EsSalud. The insured people are mainly males (50.6%) with a higher technical education level (39.7%). The insured population has mostly independent (95.0%) and own (68.1%) home. Only 34.5% of the insured practice some sport or physical exercise; 14.0% of the population suffers from a chronic disease; 3.5% have diabetes; and 7.1%, arterial hypertension. In the last three months, 35.4% of the members needed medical attention; of these, only 73.1% received health care and the remaining 10.9% were treated in pharmacies or non-formal health care services. CONCLUSIONS This survey is the first performed in the population of EsSalud affiliates, applied at the national level, and has socio-economic and demographic data of the insured, their distribution, risk factors of health, prevalence of health problems and the degree of access to health services.Inflammatory markers and occurrence of falls: Bambuí Cohort Study of Aging10.11606/s1518-8787.20190530008552017-01-30T00:05:00Z2017-01-30T00:05:00ZAmorim, Juleimar Soares Coelho deTorres, Karen Cecília LimaTeixeira-Carvalho, AndréaMartins-Filho, Olindo AssisLima-Costa, Maria FernandaPeixoto, Sérgio Viana
<em>Amorim, Juleimar Soares Coelho De</em>;
<em>Torres, Karen Cecília Lima</em>;
<em>Teixeira-Carvalho, Andréa</em>;
<em>Martins-Filho, Olindo Assis</em>;
<em>Lima-Costa, Maria Fernanda</em>;
<em>Peixoto, Sérgio Viana</em>;
<br/><br/>
ABSTRACT OBJECTIVE Analyze whether inflammatory markers are associated with falls among older adults living in Bambuí. METHODS Study that analyzed baseline data from a Bambuí Cohort Study of Aging, involving 1,250 participants. Data about falls were collected from previous 12 months, classified as single or multiple occurrence and severity (participant seeking health services). Information about sociodemographic characteristics, health behaviors and health condition was also collected and used as confounding factors. The exposures of interest included interleukins (IL-1β, IL-6, IL-8, IL-10, IL-12), tumor necrosis factor (TNF), ultra-sensitive C-reactive protein (us-CRP) and chemokines (CXCL9, CCL5, CCL10, MCP1). Data were processed through logistic regression, obtaining odds ratio and 95% confidence interval (95%CI). RESULTS The prevalence of falls was 27.1%; 40.1% of the older adults reported multiple falls and 33.3% sought health services. After adjustments, the following elevated levels were associated with falls: us-CRP (OR = 1.46, 95%CI 1.04–2.03), CCL5 (OR = 1.38, 95%CI 1.01–1.90) and CXCL9 (OR = 1.43, 95%CI 1.02–2.02). An association was observed between the number of elevated markers and the occurrence of falls: two (OR = 1.47, 95%CI 1.02–2.12) and three (OR = 2.08, 95%CI 1.12–3.87) elevated biomarkers indicated fall probability of 32.0% and 39.4%, respectively. CONCLUSIONS Elevated levels of us-CRP, CCL5 and CXCL9, which were associated with falls, may contribute to a proper understanding of the mechanism associated with the occurrence of falls among older people.VES-13 and WHOQOL-bref cutoff points to detect quality of life in older adults in primary health care10.11606/s1518-8787.20190530008022017-01-30T00:05:00Z2017-01-30T00:05:00ZSilva, Samira MonteiroSantana, Alfredo Nicodemos CruzSilva, Nayhane Nayara Barbosa daNovaes, Maria Rita Carvalho Garbi
<em>Silva, Samira Monteiro</em>;
<em>Santana, Alfredo Nicodemos Cruz</em>;
<em>Silva, Nayhane Nayara Barbosa Da</em>;
<em>Novaes, Maria Rita Carvalho Garbi</em>;
<br/><br/>
ABSTRACT OBJECTIVE: To determine Vulnerable Elders Survey (VES-13) and WHOQOL-bref cutoff points to detect poor quality of life (QoL) in older individuals. METHODS: This is a cross-sectional study, performed in all primary health care units in Samambaia, DF, Brazil. The data were collected from August 2016 to May 2017. The sample size of 466 older individuals treated in primary health care was obtained considering a 5% margin of error, 95% confidence level, 50% prevalence, and 20% possible losses, in a population of 13,259 older individuals. The subjects answered the VES-13 and WHOQOL-bref questionnaires. They were divided into 3 subgroups: poorQoL (older individuals with self-reported very poor or poor QoL AND very dissatisfied or dissatisfied with their health), goodQoL (very good or good QoL AND very satisfied or satisfied with Health) and indeterminateQoL (NOT belonging to poorQoL or goodQoL subgroups). A receiver-operating characteristic (ROC) curve was performed with poorQoL (case) versus goodQoL (control) to determine the cutoff score in VES-13 and WHOQOL-bref. A diagnostic test using these cutoffs was carried out in all older individuals (n = 466). RESULTS: The VES-13 and WHOQOL-bref cutoff points to detect poorQoL were ≥ 2 and < 60, respectively. The area under ROC curve of VES-13 and WHOQOL-bref was 0.741 (CI95% 0.659-0.823; p < 0.001) and 0.934 (CI95% 0.881-0.987; p < 0.001), respectively. In diagnostic tests, VES-13 showed 84% sensitivity and 98.2% negative predictive value, and WHOQOL-bref, 88% sensitivity and 99% negative predictive value. CONCLUSIONS: VES-13 score ≥ 2 and WHOQOL-bref score < 60 adequately detected poorQoL in patients treated in primary health care. Our data suggest that older individuals with these scores require special treatment such as geriatrics collaborative care to improve this scenario, considering QoL impact on mortality.Fetal and maternal factors are associated with mortality due to circulatory system disorders in children10.11606/s1518-8787.20190530007932017-01-30T00:05:00Z2017-01-30T00:05:00ZSalim, Thais RochaSoares, Gabriel PortoKlein, Carlos HenriqueOliveira, Gláucia Maria Moraes
<em>Salim, Thais Rocha</em>;
<em>Soares, Gabriel Porto</em>;
<em>Klein, Carlos Henrique</em>;
<em>Oliveira, Gláucia Maria Moraes</em>;
<br/><br/>
ABSTRACT OBJECTIVE To analyze the association of characteristics recorded at the time of birth, including weight, occurrence of asphyxia, gestation duration, maternal age and education level, with death from diseases or malformations of the circulatory system in children under 18 years of age. METHODS The Brazilian Information System on Live Births and Information System on Mortality databases were linked and evaluated following a longitudinal cohort analysis strategy. The following independent variables were evaluated: characteristics recorded at the time of birth, including weight, occurrence of asphyxia, gestation duration, maternal age and education level. Dependent variables were death from diseases or malformations of the circulatory system in children under 18 years of age. Crude relative risks were estimated and relative risks were adjusted for the variables. RESULTS 6,380 deaths were linked to 4,282,260 birth records, yielding 5,062 pairs considered as true. Low birth weight (RR = 2.26), asphyxia at 1 (RR = 1.72) and 5 minutes (RR = 1.51), prematurity (RR = 1.50), maternal age ≥ 40 years (RR = 2.06), and low maternal education level (RR = 1.45) increased the probability of death caused by circulatory system diseases. In the association with death by malformations of the circulatory system, the predictive variables showed the same association profile, but with greater intensity. CONCLUSIONS Fetal and maternal factors are associated with increased mortality due to diseases and malformations of the circulatory system. Measures to control these factors and improve access to their diagnosis and treatment would contribute to reducing the number of deaths caused by diseases and malformations of the circulatory system. However, the identification of environmental influences during gestation and birth on the risk of death should be carefully considered due to being influenced by genetic factors.Social inequalities in the use of contraceptives in adult women from Southern Brazil10.11606/s1518-8787.20190530008612017-01-30T00:05:00Z2017-01-30T00:05:00ZGonçalves, Tonantzin RibeiroLeite, Heloísa MarquardtBairros, Fernanda Souza deOlinto, Maria Teresa AnselmoBarcellos, Nêmora TregnagoCosta, Juvenal Soares Dias da
<em>Gonçalves, Tonantzin Ribeiro</em>;
<em>Leite, Heloísa Marquardt</em>;
<em>Bairros, Fernanda Souza De</em>;
<em>Olinto, Maria Teresa Anselmo</em>;
<em>Barcellos, Nêmora Tregnago</em>;
<em>Costa, Juvenal Soares Dias Da</em>;
<br/><br/>
ABSTRACT OBJECTIVE: To describe the contraceptive methods used by adult women and the associated socioeconomic and demographic factors. METHODS: Population-based cross-sectional study with 20 to 49-year-old women from São Leopoldo, state of Rio Grande do Sul, in 2015. Three outcomes were considered to analyze the association with demographic and socioeconomic characteristics: use of oral contraceptive pills, tubal ligation and male condom. The crude prevalence ratios, stratified by age, and 95% confidence intervals (95%CI) were obtained using Poisson regression, taking the experimental error into account. RESULTS: A total of 736 women, aged from 20 to 49 years old, were evaluated. The prevalence of the use of oral contraceptive pills, tubal ligation and male condom were respectively 31.8% (95%CI 28.4–35.3), 11.1% (95%CI 9.0–13.6) and 10.9% (95%CI 8.7–13.3). In addition, 10.5% (n = 77) of the women reported making combined use of oral contraceptive pills and condom. In the stratified analysis, younger women with lower education level and from lower social classes reported less use of oral contraceptive pills. Tubal ligation was more prevalent among the lower social classes, but only in the age group from 30 to 39 years old. No differences were found in relation to male condom. CONCLUSIONS: The results indicated that differences persist in relation to contraception, which can be associated with both the difficulties of access to these inputs and the frailty of actions in reproductive health to achieve the needs and preferences of women who are more socially vulnerable.Factors associated with depression symptoms in women after breast cancer10.11606/s1518-8787.20190530007862017-01-30T00:05:00Z2017-01-30T00:05:00ZBoing, LeonessaPereira, Gustavo SoaresAraújo, Camila da Cruz Ramos deSperandio, Fabiana FloresLoch, Monique da Silva GevaerdBergmann, AnkeBorgatto, Adriano FerretiGuimarães, Adriana Coutinho de Azevedo
<em>Boing, Leonessa</em>;
<em>Pereira, Gustavo Soares</em>;
<em>Araújo, Camila Da Cruz Ramos De</em>;
<em>Sperandio, Fabiana Flores</em>;
<em>Loch, Monique Da Silva Gevaerd</em>;
<em>Bergmann, Anke</em>;
<em>Borgatto, Adriano Ferreti</em>;
<em>Guimarães, Adriana Coutinho De Azevedo</em>;
<br/><br/>
ABSTRACT OBJECTIVE: To analyze the factors associated with the presence of depression symptoms in women after breast cancer. METHODS: Cross-sectional study with 181 women with breast cancer, aged 57.0 years (SD = 9.5), who were undergoing treatment or after treatment in the Oncology Research Center in Florianópolis, state of Santa Catarina, Brazil. The questionnaire comprised items addressing general and health information, economic level, anthropometric measures, depression symptoms (Beck Depression Inventory), self-esteem (Rosenberg Self-Esteem Scale), and body image (Body Image After Breast Cancer Questionnaire). Descriptive and inferential statistical analysis were performed by chi-square and Fisher's exact tests to verify association, Mann-Whitney U test to compare the groups and Poisson regression to identify the prevalence ratio of the factors associated with presence of depression symptoms (p < 0.05). RESULTS: We found an association between the presence of depression symptoms and the group of younger women (aged 40–60 years), those who had another disease besides cancer, those who had mastectomy surgery, those who suffered from lymphedema, and those who presented low–medium self-esteem. Less educated women presented more depressive symptoms, as did women with worse body image on the subscales of limitations, transparency, and arm concerns. CONCLUSIONS: Age, educational attainment, diagnosis of other diseases, type of surgery, lymphedema, self-esteem, and body image were factors associated with the presence of depression symptoms in Brazilian women after breast cancer. Health professionals should be aware of these relationships and try to detect depression symptoms earlier and improve the care they provide to these women.Health care are associated with worsening of frailty in community older adults10.11606/s1518-8787.20190530008292017-01-30T00:05:00Z2017-01-30T00:05:00ZCarneiro, Jair AlmeidaLima, Cássio de AlmeidaCosta, Fernanda Marques daCaldeira, Antônio Prates
<em>Carneiro, Jair Almeida</em>;
<em>Lima, Cássio De Almeida</em>;
<em>Costa, Fernanda Marques Da</em>;
<em>Caldeira, Antônio Prates</em>;
<br/><br/>
ABSTRACT OBJECTIVE To identify the factors associated with the worsening of frailty in older adults resident in the community. METHODS This is a prospective, longitudinal, and analytical study. The data collection in the baseline occurred in the participants’ homes from a random sampling by conglomerates. Demographic and socioeconomic variables, morbidities, and use of health services were analyzed. Frailty was measured by the Edmonton Frail Scale. The second data collection was performed after an average period of 42 months. The adjusted prevalence ratios were obtained by multiple Poisson regression analysis with robust variance. RESULTS A total of 394 older adults participated in both phases of the study, with 21.8% of them presenting worsening of the frailty condition. The variables that remained statistically associated with the transition to a worse state of frailty were: polypharmacy, negative self-perception of health, weight loss, and hospitalization over the past 12 months. CONCLUSIONS The factors associated with worsening of frailty along the studied period among older adults in the community were those related to health care. This result must be considered by health professionals when addressing frail and vulnerable older adults.Influence of strategic points in the dispersion of Aedes aegypti in infested areas10.11606/s1518-8787.20190530007022017-01-30T00:05:00Z2017-01-30T00:05:00ZBarbosa, Gerson LaurindoLage, Mariana de OliveiraAndrade, Valmir RobertoGomes, Antônio Henrique AlvesQuintanilha, Jose AlbertoChiaravalloti-Neto, Francisco
<em>Barbosa, Gerson Laurindo</em>;
<em>Lage, Mariana De Oliveira</em>;
<em>Andrade, Valmir Roberto</em>;
<em>Gomes, Antônio Henrique Alves</em>;
<em>Quintanilha, Jose Alberto</em>;
<em>Chiaravalloti-Neto, Francisco</em>;
<br/><br/>
ABSTRACT OBJECTIVE: To evaluate whether sites with large amount of potential breeding sites for immature forms of Aedes aegypti, called strategic points, influence in the active vector's dispersion into properties in their surroundings. METHODS: We selected four areas in the municipality of Campinas, three of them with strategic points classified as high, moderate, and low risk according to infestation and a control area, without strategic points. Between October 2015 and September 2016, we monthly installed oviposition traps and evaluated the infestation by Ae. aegypti in all properties of each selected area. To verify if there was vector dispersion from each strategic point, based on its location, we investigated the formation of clusters with excess of eggs or larvae or pupae containers, using the Gi spatial statistics. RESULTS: The amount of eggs collected in the ovitraps and the number of positive containers for Ae. aegypti did not show clusters of high values concerning its distance from the strategic point. Both presented random distribution not spatially associated with the positioning of strategic points in the area. CONCLUSIONS: Strategic points are not confirmed as responsible for the vector's dispersion for properties in their surroundings. We highlight the importance of reviewing the current strategy of the vector control program in Brazil, seeking a balance from the technical, operational, and economic point of view, without disregarding the role of strategic points as major producers of mosquitoes and their importance in the dissemination of arboviruses in periods of transmission.Perception of the operating agents about the Brazilian National School Feeding Program10.11606/s1518-8787.20190530005972017-01-30T00:05:00Z2017-01-30T00:05:00ZFerreira, Daniele MendonçaBarbosa, Roseane Moreira SampaioFinizola, Nathália CorrêaSoares, Daniele da Silva BastosHenriques, PatríciaPereira, SilviaCarvalhosa, Clarice SoaresSiqueira, Ana Beatriz Franco SenaDias, Patricia Camacho
<em>Ferreira, Daniele Mendonça</em>;
<em>Barbosa, Roseane Moreira Sampaio</em>;
<em>Finizola, Nathália Corrêa</em>;
<em>Soares, Daniele Da Silva Bastos</em>;
<em>Henriques, Patrícia</em>;
<em>Pereira, Silvia</em>;
<em>Carvalhosa, Clarice Soares</em>;
<em>Siqueira, Ana Beatriz Franco Sena</em>;
<em>Dias, Patricia Camacho</em>;
<br/><br/>
ABSTRACT OBJECTIVE Identify the perception operating agents have on the Brazilian National School Feeding Program. METHODS This is an observational, cross-sectional and quali-quantitative study developed in non-probability and convenience sampling selected in an event promoted by the National Fund for Educational Development in 2015 in Rio de Janeiro. Data were collected through questions related to pre-defined categories concerning the National School Feeding Program. The questionnaire was answered by 43 nutritionists, 41 members of the School Feeding Board, and 16 school feeding administrators from 38 cities of Rio de Janeiro. The narrative analysis was based on benchmarks of cognitive analysis of public policies. The association among variables was investigated with chi-square test, being calculated the power for association testing. RESULTS The perception of the implementation of the National School Feeding Program has been characterized by some challenges: 1) low number of nutritionists to meet the demand from schools; 2) low adhesion to the public call for the purchase of family farming products due to bureaucratic difficulties and insufficient local food production; 3) reduced coverage of food and nutritional measures due to the restriction of human, material and financial resources; and 4) limitation of the participation of the School Feeding Board due to insufficient training and transport for regular visits. The adequacy of the number of nutritionists showed statistically significant association with the purchase of family farming products (p = 0.002; power = 99%) and with the food and nutritional education activities (p = 0.021; power = 79%). CONCLUSIONS The results indicate the need for employment of nutritionist in sufficient numbers to meet the demands of the National School Feeding Program, investment in educational activities of healthy eating in schools, training of the School Feeding Board, greater availability of vehicles for school visits and assistance to family farmers in order to facilitate their participation in programs of institutional purchases and encourage the diversification of production.Lung transplantation and organ allocation in Brazil: necessity or utility10.11606/s1518-8787.20190530004452017-01-30T00:05:00Z2017-01-30T00:05:00ZRodrigues-Filho, Edison MoraesFranke, Cristiano AugustoJunges, José Roque
<em>Rodrigues-Filho, Edison Moraes</em>;
<em>Franke, Cristiano Augusto</em>;
<em>Junges, José Roque</em>;
<br/><br/>
ABSTRACT The philosophy of organ allocation is the result of two seemingly irreconcilable principles: utilitarianism and distributive justice. The process of organ donation and transplantation in Brazil reveals large inequalities between regions and units of the Federation, from the harvesting of organs to their implantation. In this context, lung transplantation is performed in only a few centers in the country and is still a treatment with limited long-term results. The allocation of the few organs harvested for the few procedures performed is defined mainly by chronology, a criterion that is not linked to necessity, which is a criterion of distributive justice, and neither to utility, a criterion of utilitarianism. This article reviews the organ allocation philosophy focusing on the case of lung transplantations in Brazil.Impact of oral condition on the quality of life of homeless people10.11606/s1518-8787.20190530007182017-01-30T00:05:00Z2017-01-30T00:05:00ZLawder, Juliana Aparecida de CamposMatos, Marcos André deSouza, João Batista deFreire, Maria do Carmo Matias
<em>Lawder, Juliana Aparecida De Campos</em>;
<em>Matos, Marcos André De</em>;
<em>Souza, João Batista De</em>;
<em>Freire, Maria Do Carmo Matias</em>;
<br/><br/>
ABSTRACT OBJECTIVE: To describe the prevalence of oral health impact on quality of life and its association with the dental condition and sociodemographic factors of homeless people. METHODS: The sample was composed of 116 adults, temporarily attended by a public institution in the municipality of Goiânia, state of Goiás. Interviews were carried out including the Oral Impact on Daily Performance instrument and sociodemographic aspects. Clinical examinations were done by a trained examiner considering criteria of the World Health Organization. We evaluated dental caries (DMFT index) and use or need to use some type of prosthesis. For the statistical analysis of data, we used Pearson's Chi-square and Fisher's exact tests and Poisson regression with robust variance. RESULTS: Of the total respondents, 81.9% had at least one daily performance affected by dental problems in the six months prior the survey. The most prevalent dental conditions were: need for lower arch (76.7%) and upper arch prosthesis (69.0%); untreated caries (75.9%); and high DMFT (57.8%). In bivariate analysis, only the need for upper prosthesis variable was associated with the impact (high Oral Impact on Daily Performance). In the regression model, adjusted for time in the institution, age, and sex, this association remained significant (p = 0.015). Individuals without need for upper prosthesis had prevalence of high impact on daily performance 55% lower than those in need of this type of prosthesis (p = 0.018). CONCLUSIONS: The prevalence of oral health impact on quality of life of homeless people was high and higher than that verified in the overall Brazilian population. The impact was associated with the need for upper prosthesis, regardless of sociodemographic characteristics of the individuals.Diabetes mellitus mortality in a municipality in the state of São Paulo, 2010 to 201410.11606/s1518-8787.20190530005612017-01-30T00:05:00Z2017-01-30T00:05:00ZLima, Rafael Aparecido DiasIstilli, Plinio TadeuTeixeira, Carla Regina de SouzaZanetti, Maria LúciaTorquato, Maria Tereza da Costa Gonçalves
<em>Lima, Rafael Aparecido Dias</em>;
<em>Istilli, Plinio Tadeu</em>;
<em>Teixeira, Carla Regina De Souza</em>;
<em>Zanetti, Maria Lúcia</em>;
<em>Torquato, Maria Tereza Da Costa Gonçalves</em>;
<br/><br/>
ABSTRACT OBJECTIVE: To describe diabetes mellitus mortality according to sex and age in a municipality in the state of São Paulo, in the period ranging from 2010 to 2014. METHODS: This was a temporal series ecological study carried out in Ribeirão Preto, state of São Paulo. The data was comprised of information on 583 deaths of Ribeirão Preto residents – regardless of the place of death – from 2010 to 2014. The data source was the electronic system of the Epidemiological Surveillance of the Municipal Health Department of the evaluated municipality. Sex, age group, premature death and year of death were chosen as variables. Subsequently, age-standardized mortality rates were calculated using the World Health Organization's standard population, in addition to total and average per death potential years of life lost. RESULTS: Mortality due to diabetes mellitus in the municipality increased during the studied period. There was a higher occurrence of female deaths, especially in the ≥ 80 years age group. The highest rates of age-standardized mortality were male. For both sexes, there was an annual mean increase of 9% in premature mortality during the studied period. Diabetes decreased life expectancy by 10 years. CONCLUSIONS: As a diagnosis of local health care, the significant increase in age-standardized mortality rates, premature mortality and potential years of life lost in the studied municipality point to the need for improvements in health promotion and disease prevention measures. It is our hope that the results presented in this study contribute to the monitoring of mortality rates in the coming years.Sociocultural factors related to the physical activity in boys and girls: PeNSE 201210.11606/s1518-8787.20190530005162017-01-30T00:05:00Z2017-01-30T00:05:00ZCondessa, Luciano AntonacciChaves, Otaviana CardosoSilva, Fernanda MarcelinaMalta, Deborah CarvalhoCaiaffa, Waleska Teixeira
<em>Condessa, Luciano Antonacci</em>;
<em>Chaves, Otaviana Cardoso</em>;
<em>Silva, Fernanda Marcelina</em>;
<em>Malta, Deborah Carvalho</em>;
<em>Caiaffa, Waleska Teixeira</em>;
<br/><br/>
ABSTRACT OBJECTIVE: To verify in male and female Brazilian adolescents the association of demographic, psychosocial, behavioral and sociocultural characteristics with the regular practice of physical activity. METHODS: The sample consisted of 109,104 adolescents from all Brazilian states attending the 9th year of elementary education in 2012. The response variable was the regular practice of physical activity (300+ minutes/week). The explanatory variables were grouped into four fields: demographic, psychosocial, behavioral and sociocultural. The Poisson regression was stratified by sex to evaluate the association. RESULTS: The prevalence of active adolescents was 20.2%, higher in boys (27.9%) than in girls (13.1%). It was observed a greater practice of physical activity in boys of lower age group, children of mothers with higher schooling, who consumed healthy foods such as beans, fruits, vegetables, and milk, as well as among those with family supervision. At the same time, unhealthy habits such as insomnia and alcohol consumption were also positively associated with physical activity. In girls, greater physical activity was observed among those who lived with mothers and whose mothers had higher schooling. In addition to family supervision, the practice of physical activity in girls was also positively associated with the frequency of meals with their parents. However, as in boys, insomnia and alcohol consumption were associated with an increase in the practice of physical activity. CONCLUSIONS: One-fifth of adolescents practice physical activity regularly, demonstrating the need for specific public policies to increase the percentage of active young people in the country. Maternal schooling, healthy eating habits and family supervision were associated with regular physical activity in boys and girls, evidencing the importance of the family for the acquisition of healthy habits in this age group.Fetal mortality and the challenges for women's health care in Brazil10.11606/s1518-8787.20190530007142017-01-30T00:05:00Z2017-01-30T00:05:00ZBarros, Patrícia de SáAquino, Érika Carvalho deSouza, Marta Rovery de
<em>Barros, Patrícia De Sá</em>;
<em>Aquino, Érika Carvalho De</em>;
<em>Souza, Marta Rovery De</em>;
<br/><br/>
ABSTRACT OBJECTIVE: To establish a historical series of fetal mortality in Brazil and regions between 1996 and 2015, identifying its behavior and trend. METHODS: A descriptive study on cases of fetal deaths in Brazil and in each region reported from 1996 to 2015, registered in DATASUS and classified by ICD-10. Maternal age and schooling, duration of gestation and type of delivery were considered. We calculated the fetal mortality rate between 1996 and 2015 to build historical series. RESULTS: The time series shows a steady chart of the fetal mortality rate (FMR) from 2000 in Brazil and in all regions. The country's fetal mortality rate rose from 8.19 in 1996 to 9.50 per 1,000 births in 2015. There was an increasing trend in fetal deaths whose root cause appears in chapter XVII of ICD-10 in Brazil and in all regions. Deaths from Chapter XVI causes showed a trend of increase only in the Northeast region, while other basic causes showed a trend of increase in the Southeast and South regions. In the Brazilian scope, there was an increasing trend of fetal deaths in mothers in the 10-14 and 25-44 years age groups. In Brazil and in all regions, there was an increase of the FMR in women with more than 8 years of schooling. Fetal deaths predominated between 28 and 36 weeks of gestation, with a growing trend in Brazil and all regions, except in the South (steady). Vaginal delivery prevailed, with a steady trend, while cesarean sections showed an increasing trend in Brazil and in all regions. CONCLUSIONS: The quality of information about fetal deaths, investments in research committees, and improvement in the quality of prenatal care should be prioritized to enable more effective coping and to reduce the fetal mortality rate in Brazil.Contextual income and incidence of disability: results of EpiFloripa Elderly Cohort10.11606/s1518-8787.20190530006592017-01-30T00:05:00Z2017-01-30T00:05:00ZDanielewicz, Ana Lúciad’Orsi, EleonoraBoing, Antonio Fernando
<em>Danielewicz, Ana Lúcia</em>;
<em>D’orsi, Eleonora</em>;
<em>Boing, Antonio Fernando</em>;
<br/><br/>
ABSTRACT OBJECTIVE: Evaluate the association between contextual income and the incidence of disability in basic and instrumental activities of daily living. METHODS: This is a cohort study, with sample of elderly individuals (n = 1,196) residing in Florianópolis, state of Santa Catarina, Brazil. The incidence of disabilities was evaluated using reports of difficulty or inability to perform six basic activities of daily living and nine instrumental activities of daily living after four years. Contextual income was obtained from the 2010 Census. We conducted multilevel logistic regression analyses with adjustment models for individual variables. RESULTS: The incidence of disability in basic activities of daily living was 15.8% (95%CI 13.8–17.9) and in instrumental activities of daily living incidence was 13.4% (95%CI 11.6–15.5). We observed significant association between contextual income and incidence of disability in basic activities of daily living. Having as reference the elderly living in the lower income tercile, those who lived in the intermediary terciles and in that of highest income had 37% (95%CI 0.41–0.96) and 21% (95%CI 0.52–1.19) lower chances of developing disability, respectively. For the incidence of disability in instrumental activities of daily living we observed no statistically significant associations. CONCLUSIONS: Contextual income influences the development of disability in basic activities of daily living in the elderly and should be the subject of actions to reduce socioeconomic inequalities and promote longevity with independence.Dental care for early childhood in Brazil: from the public policy to evidence10.11606/s1518-8787.20190530005402017-01-30T00:05:00Z2017-01-30T00:05:00ZEssvein, GustavoBaumgarten, AlexandreRech, Rafaela SoaresHilgert, Juliana BalbinotNeves, Matheus
<em>Essvein, Gustavo</em>;
<em>Baumgarten, Alexandre</em>;
<em>Rech, Rafaela Soares</em>;
<em>Hilgert, Juliana Balbinot</em>;
<em>Neves, Matheus</em>;
<br/><br/>
ABSTRACT OBJECTIVE: To evaluate whether characteristics of health services, oral health team and dental surgeon are associated with provision of dental care for children up to five years old in Brazilian Primary Health Care. METHODS: A cross-sectional study was conducted with data from 18,114 oral health teams in Brazil, evaluated in 2014 by the National Program for Access and Quality Improvement in Primary Care. The study outcome was the proven performance of dental procedures on children up to five years old. Statistical analysis was performed by Poisson regression based on a hierarchical model, where the first level was composed of service organization variables, the intermediate level composed of unit planning characteristics, and the proximal level composed of variables related to dental surgeon characteristics. RESULTS: Prevalence of dental care performed by oral health teams was 80.9% (n = 14,239). Scheduled appointments and activities of education in health were positively associated with the outcome, as well as planning and programming activities for the population and monitoring and analysis of oral health indicators. Complementary training in public health, continuing education activities and career plan were variables related to dental surgeons associated with the service provision. CONCLUSIONS: One fifth of health units in Brazil do not provide dental care for children in early childhood. Health units’ well-structured organization and planning protocols are associated with the provision of this service, as well as better employment relationship and graduate activities for dental surgeons.Validation of an anxiety scale for prenatal diagnostic procedures10.11606/s1518-8787.20190530006212017-01-30T00:05:00Z2017-01-30T00:05:00ZKindermann, LucasTraebert, JeffersonNunes, Rodrigo Dias
<em>Kindermann, Lucas</em>;
<em>Traebert, Jefferson</em>;
<em>Nunes, Rodrigo Dias</em>;
<br/><br/>
ABSTRACT OBJECTIVE: To perform a cross-cultural adaptation of the Prenatal Diagnostic Procedures Anxiety Scale questionnaire for application in the Brazilian cultural context. METHODS: The translation and back translation processes followed internationally accepted criteria. A committee of experts evaluated the semantic, idiomatic, experimental and conceptual equivalence, proposing a pre-final version that was applied in 10.0% of the final sample. Afterwards, the final version was approved for the psychometric analysis. At that stage, 55 pregnant women participated which responded to the proposed Brazilian version before taking an ultrasound examination at a public hospital in Santa Catarina, in the year of 2017. The Edinburgh Postnatal Depression Scale was used as an external reliability parameter. The internal consistency of the instrument was obtained by Cronbach's alpha. Validation was performed by exploratory factorial analysis with extraction of principal components by the Kaiser-Guttman method and Varimax rotation. RESULTS: The Cronbach's alpha value of the total instrument was 0.886, and only the percentage of variance from item 2 (0.183) was not significant. The Kaiser-Guttman criterion defined three factors responsible for explaining 78.5% of the variance, as well as the Scree plot. Extraction of the main components by the Varimax method presented values from 0.713 to 0.926, with only item 2 being allocated in the third component. CONCLUSIONS: The Brazilian version is reliable and valid for use in the diagnosis of anxiety related to the performance of ultrasound procedures in prenatal care. Due to the lack of correlation with the rest of the construct, it is suggested that item 2 be removed from the final version.The human exposome unraveling the impact of environment on health: promise or reality?10.11606/s1518-8787.20190530006492017-01-30T00:05:00Z2017-01-30T00:05:00ZOlympio, Kelly Polido KaneshiroSalles, Fernanda JunqueiraFerreira, Ana Paula Sacone da SilvaPereira, Elizeu ChiodiOliveira, Allan Santos deLeroux, Isabelle NogueiraVieira, Flávia Bosquê Alves
<em>Olympio, Kelly Polido Kaneshiro</em>;
<em>Salles, Fernanda Junqueira</em>;
<em>Ferreira, Ana Paula Sacone Da Silva</em>;
<em>Pereira, Elizeu Chiodi</em>;
<em>Oliveira, Allan Santos De</em>;
<em>Leroux, Isabelle Nogueira</em>;
<em>Vieira, Flávia Bosquê Alves</em>;
<br/><br/>
ABSTRACT Considering the innovative nature of the approach to human exposome, we present the state of the art of studies on exposome, and discuss current challenges and perspectives in this area. Several reading and discussion activities were conducted by the Expossoma e Saúde do Trabalhador (eXsat – Group Exposome and Worker's Health), with systematization of the literature in the area published between January 2005 and January 2017, available in the databases PubMed and Web of Science. This comment brings a thematic analysis to encourage the dissemination of the exposome approach for studies in the Public Health area.Aspects of work and sleep associated with work ability in regular aviation pilots10.11606/s1518-8787.20190530003452017-01-30T00:05:00Z2017-01-30T00:05:00ZPellegrino, PollyannaMarqueze, Elaine Cristina
<em>Pellegrino, Pollyanna</em>;
<em>Marqueze, Elaine Cristina</em>;
<br/><br/>
ABSTRACT OBJECTIVE: Analyze the association of work organization and sleep aspects with work ability in regular aviation pilots. METHODS: This is a cross-sectional epidemiological study with 1,234 regular aviation pilots who worked domestic and international flights, affiliated with the Brazilian Association of Civil Aviation Pilots. Data collection employed online questionnaire. We compared proportions using Pearson's Chi-squared or Fisher's exact hypothesis tests. Then, we conducted Poisson analysis, with robust variance, to test factors associated with moderate or low work ability. RESULTS: The prevalence of moderate or low work ability was 43.3%. We found that self-perception of insufficient sleep (PR = 1.29; 95%CI 1.06–1.57), increased perception for fatigue (PR = 1.51; 95%CI 1.24–1.84), more than 65 flight hours per month (PR = 1.22; 95%CI 1.01–1.46), less than 10 days of time off per month (PR = 1.27; 95%CI 1.04–1.55), and frequent operational delays (PR = 1.23; 95%CI 1.02–1.48) were factors associated with moderate or low work ability. CONCLUSIONS: Work organization was a determining factor for decreased work ability, especially concerning aspects related to rest and its influence on the sleep of pilots.Resilience and mental health problems in children and adolescents who have been victims of violence10.11606/s1518-8787.20190530003912017-01-30T00:05:00Z2017-01-30T00:05:00ZHildebrand, Natália AmaralCeleri, Eloisa Helena Rubello VallerMorcillo, André MorenoZanolli, Maria de Lurdes
<em>Hildebrand, Natália Amaral</em>;
<em>Celeri, Eloisa Helena Rubello Valler</em>;
<em>Morcillo, André Moreno</em>;
<em>Zanolli, Maria De Lurdes</em>;
<br/><br/>
ABSTRACT OBJECTIVE: To understand the process of resilience (social support and resources of the family environment) and the chance of mental health problems in children and adolescents (9–16 years) who have been victims of domestic violence, assisted in specialized services (Group 1 – G1) and in school services without reports of domestic violence (Group 2 – G2). METHODS: Various semi-structured instruments were applied to the pairs (guardian and child or adolescent): the Strengths and Difficulties Questionnaire (SDQ); the Resiliency Scales for Children and Adolescents (RSCA), including Scale I (SI – sense of control), Scale II (SII – relationship skills) and Scale III (SIII – emotional reactivity); the Social Support Appraisals; the Home Environment Resources Scale and a questionnaire created by the authors to characterize the population. RESULTS: There was no difference in the prevalence of resilience between G1 and G2. Children and adolescents of both groups had a higher chance of low resilience in the absence of perception of social support from the teacher (SI; SIII) and other people in the community (SI; SII). Girls had higher chance of low resilience (SIII). The establishment of routine or rules in the lives of the children and adolescents facilitated the development of resilience (SIII). In G1, the prevalence of mental health problems was 65% for the self-application version of the SDQ for children and adolescents (SDQ/CA) and 54% for the version answered by the guardians (SDQ/G). In G2, it was 33% for SDQ/CA and 37.9% for SDQ/G. Domestic violence against children and adolescents was a risk factor for the development of mental disorders (SDQ/G). Subjects with low resilience (SI) had a higher chance of developing mental health problems (SDQ/CA). Despite originating from the same regions, the groups had socioeconomic differences, which showed no relationship with resilience. CONCLUSIONS: The quality and perception of social support and resources present in the home environment may have facilitated the development of resilience in the studied children and adolescents. Violence may have increased the chance of mental health problems, domestic violence being an aggravating factor. There is need for research on aspects that predict resilience and investment in intervention strategies for this population, as a way to promote mental health.Maternity leave and exclusive breastfeeding10.11606/s1518-8787.20190530002442017-01-30T00:05:00Z2017-01-30T00:05:00ZRimes, Karina AbibiOliveira, Maria Inês Couto deBoccolini, Cristiano Siqueira
<em>Rimes, Karina Abibi</em>;
<em>Oliveira, Maria Inês Couto De</em>;
<em>Boccolini, Cristiano Siqueira</em>;
<br/><br/>
ABSTRACT OBJECTIVE: To analyze the association between maternity leave and exclusive breastfeeding and to estimate the prevalence of exclusive breastfeeding in children under six months of life. METHODS: Cross-sectional study, with mothers of children under six months of life, attended in primary health care units with Breast Milk Collection Services in the municipality of Rio de Janeiro, Brazil, in 2013 (n = 429). We analyzed characteristics concerning: maternal sociodemographic aspects, household, prenatal care, childbirth, maternal lifestyle, the child, health care, and infant feeding. Adjusted prevalence ratios (APR) were obtained by Poisson regression with robust variance according to hierarchical approach, and we kept in the final model variables that were associated (p ≤ 0.05) with exclusive breastfeeding (outcome). RESULTS: Among the interviewed mothers, 23.1% were on maternity leave and 17.2% were working. The prevalence of exclusive breastfeeding was 50.1%. The maternal work with maternity leave was associated with higher prevalence of the outcome (APR = 1.91; 95%CI 1.32–2.78), compared with mothers who worked without maternity leave. CONCLUSIONS: Maternity leave has contributed to the practice of exclusive breastfeeding for children under six months of life, which indicates the importance of this benefit in protecting exclusive breastfeeding for women inserted in the formal labor market.Study of Chronic Diseases (Edoc): methodological aspects10.11606/s1518-8787.20190530008472017-01-30T00:05:00Z2017-01-30T00:05:00ZAmaral, Thatiana Lameira MacielAmaral, Cledir de AraújoPortela, Margareth CrisóstomoMonteiro, Gina Torres RegoVasconcellos, Maurício Teixeira Leite de
<em>Amaral, Thatiana Lameira Maciel</em>;
<em>Amaral, Cledir De Araújo</em>;
<em>Portela, Margareth Crisóstomo</em>;
<em>Monteiro, Gina Torres Rego</em>;
<em>Vasconcellos, Maurício Teixeira Leite De</em>;
<br/><br/>
ABSTRACT OBJECTIVE: Describe the sampling design and other methodological aspects of the Study of Chronic Diseases (Edoc). METHODS: Edoc comprises two household surveys with distinct populations, one with adults aged 18 to 59 years (Edoc-A) and another with older adults aged 60 years or more (Edoc-I), living in Rio Branco, Acre. The selection of the participants used complex samples by clusters in two stages of selection, census enumeration areas (CEA) and household. In the first stage, common to both surveys, 40 CEAs were selected with probability proportional to size, and in the second stage, independent for each survey, households were selected with equal probability, and all the residents eligible for each survey were selected. Sampling weights were estimated by the inverse of the product of inclusion probabilities at each stage and then calibrated to produce unbiased population estimates. Interviews were held with questionnaires about socioeconomic and demographic conditions, life habits and health conditions. Anthropometric measures focused on measures of body height, girths and mass, while the vital signs analyzed were blood pressure, heart rate and respiratory rate. Blood and urine samples were collected for analysis. RESULTS: The Edoc comprised 1,701 participants, 685 of Edoc-A and 1,016 of Edoc-I. Considering the loss of information of some participants and the need of studying specific themes with production of population inferences, 16 subsamples of complete information by theme were generated and two subsamples were exclusive of Edoc-I. CONCLUSIONS: The Edoc has as important developments the analyses of epidemiological profile of the population from the capital of the state of Acre, contributing to the production of knowledge in public health with useful information for decisions in public health policies.WHODAS 2.0-BO: normative data for the assessment of disability in older adults10.11606/s1518-8787.20190530005862017-01-30T00:05:00Z2017-01-30T00:05:00ZFerrer, Michele Lacerda PereiraPerracini, Monica RodriguesRebustini, FlávioBuchalla, Cassia Maria
<em>Ferrer, Michele Lacerda Pereira</em>;
<em>Perracini, Monica Rodrigues</em>;
<em>Rebustini, Flávio</em>;
<em>Buchalla, Cassia Maria</em>;
<br/><br/>
ABSTRACT OBJECTIVE: To examine the normative data of WHODAS 2.0-BO for older Brazilians (World Health Disability Assessment Schedule – Brazilian version for older people) and its distribution according to sex, age, health, subjective health perception, performance in a mobility test and presence of chronic diseases and depression. METHODS: Cross-sectional study, with 350 participants with 60 years of age or older, men and women, patients of a geriatric specialized center for medical consultations or rehabilitation. The older adults were evaluated using a semi-structured questionnaire containing demographic and clinical data (WHODAS 2.0-BO) and the geriatric depression scale (GDS), having been subsequently subjected to a mobility test (Timed Up and Go). The data were analyzed via their distribution in percentiles of the population and via analysis of variance. RESULTS: Two-hundred and sixty-six (76%) participants were women, and the average age was 71.8 (DP = 6.7) years old. The average score in WHODAS 2.0-BO was 4.3 (DP = 5.2) points, the highest value found having corresponded to 33 points. The average time for the Timed Up and Go test was 10.0 (SD = 3.2) seconds. About 30% of the older adults did not report any difficulties in the tasks evaluated by WHODAS 2.0-BO and half of the sample scored up to two points. CONCLUSIONS: A score corresponding to 12 points in the 90 percentile on a scale from zero to 40 was observed, which suggests severe disability. The score in WHODAS 2.0-BO increased with the advance in age, as well as in the presence of comorbidities, negative health perception, depression, high blood pressure, visual and hearing impairment and mobility impairment.Assisted reproductive technology: prevalence and associated factors in Southern Brazil10.11606/s1518-8787.20190530007372017-01-30T00:05:00Z2017-01-30T00:05:00ZSilva, Shana Ginar daBertoldi, Andréa DâmasoSilveira, Mariângela Freitas daDomingues, Marlos RodriguesEvenson, Kelly RSantos, Iná Silva dos
<em>Silva, Shana Ginar Da</em>;
<em>Bertoldi, Andréa Dâmaso</em>;
<em>Silveira, Mariângela Freitas Da</em>;
<em>Domingues, Marlos Rodrigues</em>;
<em>Evenson, Kelly R</em>;
<em>Santos, Iná Silva Dos</em>;
<br/><br/>
ABSTRACT OBJECTIVE: To assess the prevalence of successful assisted reproductive technology and to identify the associated factors. METHODS: This population-based birth cohort study was carried out with 4,333 pregnant women expected to deliver in 2015 in the urban area of Pelotas, Southern Brazil. Use of an assisted reproductive technology procedure, type of assisted reproductive technology [in vitro fertilization or intracytoplasmic sperm injection or artificial insemination], number of embryos transferred, success of embryo transfer, number of attempts, and reported reasons for seeking assisted reproductive technology were the main outcomes measured. Use of an assisted reproductive technology procedure was analyzed according to sociodemographic, nutritional, reproductive history, and behavioral characteristics. Unadjusted and adjusted analyses were performed by logistic regression. RESULTS: Among the 4,275 newborns enrolled in the Pelotas 2015 Birth Cohort Study, 18 births (0.4%) were conceived by assisted reproductive technology. Most cases of assisted reproductive technology were by in vitro fertilization (70.6%). All cycles were performed in private clinics under direct out-of-pocket payment. Even after controlling for confounders, maternal age > 35 years, nulliparity and high family monthly income were strongly associated with assisted reproductive technology. CONCLUSIONS: The use of assisted reproductive technology services was reported by only a few women in the Pelotas 2015 Birth Cohort Study. Our study highlights sociodemographic factors associated to assisted reproductive technology procedures. To better understand the patterns and barriers in overall use of assisted reproductive technology services over time, national-level trend studies in assisted reproductive technology treatments and outcomes, as well as studies exploring the characteristics of women who have sought this kind of treatment are needed in low-middle income countries.Interventions to reduce the prescription of inappropriate medicines in older patients10.11606/s1518-8787.20190530007812017-01-30T00:05:00Z2017-01-30T00:05:00ZSantos, Nathalia Serafim dosMarengo, Lívia LuizeMoraes, Fabio da SilvaBarberato Filho, Silvio
<em>Santos, Nathalia Serafim Dos</em>;
<em>Marengo, Lívia Luize</em>;
<em>Moraes, Fabio Da Silva</em>;
<em>Barberato Filho, Silvio</em>;
<br/><br/>
ABSTRACT OBJECTIVE: Identify and critically evaluate systematic reviews addressing the effectiveness of interventions to reduce the number of prescriptions of potentially inappropriate medication to older patients. METHODS: This is an overview of systematic reviews. The studies were searched and selected from Medline, Cochrane Library, Embase, CINAHL, Virtual Health Library, and Web of Science databases, combining the terms aged, prescriptions, inappropriate prescribing and potentially inappropriate medication list with their entry terms and other related descriptors, published by June 2017. This study included systematic reviews with or without meta-analysis that addressed the effectiveness of any intervention or combined interventions to reduce the number of prescriptions of potentially inappropriate medications to older patients, without restriction in terms of design, language or date of publication of primary studies. AMSTAR – A MeaSurement Tool to Assess systematic Reviews – was used to evaluate the methodological quality of selected systematic reviews. Study selection and the methodological quality evaluation were performed by two independent evaluators, who resolved any divergence by consensus. The main findings were grouped into thematic categories, defined after a content analysis and discussed qualitatively as narrative synthesis. RESULTS: This study analyzed 24 systematic reviews. In terms of study design and methodological quality evaluation, most were systematic reviews of randomized controlled clinical trials and studies of moderate quality, respectively. The interventions were analyzed in five thematic categories: medication review services, pharmaceutical interventions, computerized systems, educational interventions, and others. The interventions analyzed showed good results and most of them helped reduce the number of prescriptions of potentially inappropriate medication to older patients. CONCLUSIONS: The systematic reviews included in this overview showed potential benefits of different interventions. However, it was not possible to determine the most effective intervention. Combined interventions are likely to provide better results than isolated interventions.Use of psychoactive drugs predicts functional disability among older adults10.11606/s1518-8787.20190530006752017-01-30T00:05:00Z2017-01-30T00:05:00ZFalci, Denise MourãoMambrini, Juliana Vaz de MeloCastro-Costa, ÉricoFirmo, Josélia Oliveira AraújoLima-Costa, Maria FernandaLoyola Filho, Antônio Ignácio de
<em>Falci, Denise Mourão</em>;
<em>Mambrini, Juliana Vaz De Melo</em>;
<em>Castro-Costa, Érico</em>;
<em>Firmo, Josélia Oliveira Araújo</em>;
<em>Lima-Costa, Maria Fernanda</em>;
<em>Loyola Filho, Antônio Ignácio De</em>;
<br/><br/>
ABSTRACT OBJECTIVE: Investigate whether the use of psychoactive drugs would be a predictor of incidence of functional disability among seniors living in community. METHODS: It is a population-based longitudinal study, developed between January 1, 1997 and December 31, 2011, with older adults living in community. The association between the use of psychoactive drugs and the development of functional disability for instrumental (IADLs) and basic (BADLs) activities of daily living was tested using the extended Cox proportional hazards model, which considers the measure of exposure of interest throughout the follow-up period. The analyses were stratified by sex and adjusted by sociodemographic characteristics, health behavior and health conditions. RESULTS: After multivariate adjustment, the use of two or more psychoactive drugs in the female stratum was associated with disability for both IADLs (HR = 1.58; 95%CI 1.17–2.13) and BADLs (HR = 1.43; 95%CI 1.05–1.94), the use of benzodiazepines was associated with disability for IADLs (HR = 1.32; 95%CI 1.07–1.62), and the use of antidepressants was associated with disability for both IADLs (HR = 1.51; 95%CI 1.16–1.98) and BADLs (HR = 1.44; 95%CI 1.10–1.90). In the male stratum, the use of antipsychotics was associated with disability for IADLs (HR = 3.14; 95%CI 1.49–6.59). CONCLUSIONS: The study showed a prospective association between the use of psychoactive drugs and functional disability. These results indicate the need to carefully assess the prescription of psychoactive drugs for older adults and monitor their usage in order to detect damages to the health of users.Clinical pathways of breast cancer patients treated in the Federal District, Brazil10.11606/s1518-8787.20190530004062017-01-30T00:05:00Z2017-01-30T00:05:00ZBarros, Ângela FerreiraAraújo, Jeniffer Melo deMurta-Nascimento, CristianeDias, Adriano
<em>Barros, Ângela Ferreira</em>;
<em>Araújo, Jeniffer Melo De</em>;
<em>Murta-Nascimento, Cristiane</em>;
<em>Dias, Adriano</em>;
<br/><br/>
ABSTRACT OBJECTIVE: To identify the clinical pathways of women with breast cancer treated in public hospitals, and to analyze the factors that influence the time interval between the first appointment and the start of therapy. METHODS: A cross-sectional study was conducted with 600 women with breast cancer treated in nine public hospitals in the Brazilian Federal District. Patients were interviewed between September 2012 and September 2014. Simple and multiple logistic regression models were adjusted to evaluate the variables associated with the time interval studied. The most frequent pathway was the one that started in primary care with following care in the therapy service (28.9%). In the multiple adjustment, factors associated to a longer time interval between the first appointment and therapy were: lower family income (OR = 1.89; 95%CI 1.32–2.68), the first appointment in public services (OR = 1.78; 95%CI 1.20–2.64), care in more than two health services in the clinical pathway (OR = 1.71; 95%CI 1.19–2.44); and obtaining the anatomopathological analysis of the biopsy in public services instead of private health services (OR = 1.87; 95%CI 1.29–2.71). Independently, the implementation of specialist appointment scheduling, with care regulation, was associated with a shorter time interval between first appointment and therapy (OR = 0.33; 95%CI 0.16–0.65). CONCLUSIONS: We observed that multiple pathways were covered by women with breast cancer treated in public services of the Federal District. Socioeconomic iniquities and several aspectos of the pathways covered were associated with a longer time interval between the first appointment and the start of breast cancer therapy.Impacts of a Brazilian pharmaceutical program on the health of chronic patients10.11606/s1518-8787.20190530007332017-01-30T00:05:00Z2017-01-30T00:05:00ZAlmeida, Aléssio Tony Cavalcanti deSá, Edvaldo Batista deVieira, Fabiola SulpinoBenevides, Rodrigo Pucci de Sá e
<em>Almeida, Aléssio Tony Cavalcanti De</em>;
<em>Sá, Edvaldo Batista De</em>;
<em>Vieira, Fabiola Sulpino</em>;
<em>Benevides, Rodrigo Pucci De Sá E</em>;
<br/><br/>
ABSTRACT OBJECTIVE: To evaluate the impact of the expansion of access to medicines by the Programa Farmácia Popular do Brasil (PFPB – Brazilian Popular Pharmacy Program) on the indicators of hospitalizations and deaths by hypertension and diabetes. METHODS: To estimate the impact of the Brazilian Popular Pharmacy Program, the statistical model of fixed-effect difference in differences was used, considering: the divisions Rede Própria (RP – Proprietary Network) and Rede Conveniada (RC – Partnership Network); the exposure time of the municipality to the program; intramunicipal density, measured by the number of accredited establishments; and the coverage spillover effect into patients from nonparticipating municipalities. Data from 5,566 municipalities were used, for the period from 2003 to 2016, including: (i) administrative records of the PFPB, Sistema de Informações sobre Mortalidade (SIM – Information System on Mortality), and Sistema de Informações Hospitalares (SIH – Hospital Information System); ii) other health data managed by the Departamento de Informática do SUS (DATASUS – Department of Informatics of SUS); iii) sociodemographic data produced by the Brazilian Institute of Geography and Statistics (IBGE); and iv) data from the Relação Anual de Informações Sociais (RAIS – Annual List of Social Information). RESULTS: The expansion of access to medicines for treatment of hypertension and diabetes resulted in a meaningful and statistically significant reduction (p < 0.05) of the number of hospitalizations and deaths by these diseases, in an average annual rate of 27.6% and 8.0%, respectively. The observed impacts were induced by the partnership network, highlighting the density of establishments per 100,000 inhabitants and, above all, the exposure time of the municipality to the program as relevant to the effect. Evidence of a spillover effect and of the maintenance of impacts on different age groups, especially older people, were also observed. CONCLUSIONS: The strategy to expand access to medicines through the PFPB was effective in reducing hospitalizations and deaths by hypertension and diabetes in Brazil during the investigated period. Better understanding the impacts of the program is important to improve the pharmaceutical care policy, to ensure access to cost-effective treatments.Socioeconomic inequality in dietary intake begins before 24 months in Brazilian children10.11606/s1518-8787.20190530006792017-01-30T00:05:00Z2017-01-30T00:05:00ZRinaldi, Ana Elisa MadalenaConde, Wolney Lisboa
<em>Rinaldi, Ana Elisa Madalena</em>;
<em>Conde, Wolney Lisboa</em>;
<br/><br/>
ABSTRACT OBJECTIVE: To assess dietary patterns by socioeconomic gradient of Brazilian infants and young children in 2006 and 2013. METHODS: Data from the National Demographic Survey (2006) and the National Health Survey (2013) were used. Food intake were described by wealth index, age range and survey year. Dietary patterns were defined by principal component analysis. Association of wealth index and dietary patterns were modelled using linear regression. RESULTS: Breast milk intake was higher for poor infants and young children, while fresh food intake (fruits, vegetables, meats, beans) was higher for the richer ones in 2006 and 2013. Biscuits and sweetened beverages were more consumed by rich infants and young children in 2006 and by poor and rich children in 2013. Three dietary patterns (DP1, DP2, and DP3) were identified in 2006 and four in 2013 (DP1, DP2, DP3, and DP4). DP1 was composed mainly of fresh foods, and it was positively associated with the wealth index for infants and young children in both years. DP2 was composed of biscuits, cookies and sweetened beverages, and it was positively associated with the wealth index for young children in 2006 and for poor and rich infants and young children in 2013. DP3 was composed of milk, water and porridge in both years, and it was not associated with the wealth index. DP4 was composed of breast milk and porridge, and it was negatively associated with the wealth index. CONCLUSIONS: DP1 is a characteristic pattern for richer infants and young children since 2006, while DP2 is a characteristic pattern for all infants and young children in 2013, regardless of wealth index. Dietary inequality between the poor and the rich seems to begin in childhood.Cross-cultural adaptation and psychometric properties of the Brazilian-Portuguese version of the Quality of Prenatal Care Questionnaire (QPCQ)10.11606/s1518-8787.20190530005652017-01-30T00:05:00Z2017-01-30T00:05:00ZNunes, Rodrigo DiasParma, Gabriel CremonaCampos, Andressa Cardoso deLocatelli, PaulaTraebert, Jefferson
<em>Nunes, Rodrigo Dias</em>;
<em>Parma, Gabriel Cremona</em>;
<em>Campos, Andressa Cardoso De</em>;
<em>Locatelli, Paula</em>;
<em>Traebert, Jefferson</em>;
<br/><br/>
ABSTRACT OBJECTIVE To translate and to observe the psychometric measures of the Brazilian version of the Quality of Prenatal Care Questionnaire. METHODS The translation protocol followed the standards of the International Society for Pharmacoeconomics and Outcomes Research. Descriptive statistics were performed to identify characteristics of 280 literate postpartum women in a public hospital. We examined the internal consistency using Cronbach's alfa. To determine the test-retest reproducibility and the instrument's stability, we performed the intraclass correlation coefficient and Bland and Altman plot between two applications. We investigated the item's properties using the item response theory. RESULTS The overall Cronbach's alpha index was 0.975. The intraclass correlation coefficient was 0.995 (95%CI 0.993-0.996) and a uniform distribution was visualized at the Bland and Altman plot. The item response theory identified the discriminatory power and the difficulty level of the instrument and of each item. The instrument showed acute angulation of the expected total score, and good concentrate information and good standard error curves, preserving the latent construct and its original items. CONCLUSIONS This analysis concluded that the Brazilian version of the Quality of Prenatal Care Questionnaire is a high-quality, reliable and valid questionnaire to determine the quality of prenatal care among Brazilian women. The questionnaire is suitable for the cultural context represented.Association between diabetes mellitus and depressive symptoms in the Brazilian population10.11606/s1518-8787.20190530006082017-01-30T00:05:00Z2017-01-30T00:05:00ZBriganti, Cauê PontesSilva, Marcus TolentinoAlmeida, José Vanilton deBergamaschi, Cristiane de Cássia
<em>Briganti, Cauê Pontes</em>;
<em>Silva, Marcus Tolentino</em>;
<em>Almeida, José Vanilton De</em>;
<em>Bergamaschi, Cristiane De Cássia</em>;
<br/><br/>
ABSTRACT OBJECTIVE To determine the prevalence of current depressive symptoms in people with diabetes mellitus and their association with the disease. METHODS Data were collected from the Brazilian National Health Survey (Pesquisa Nacional de Saúde - PNS), a cross-sectional, population-based study conducted in 2013. Study participants were selected by simple random cluster sampling in three stages: census tracts, households, and residents aged ≥ 18 years. The presence of diabetes was self-reported, whereas the presence of current depressive symptoms was determined by the Patient Health Questionnaire-9 (PHQ-9) and mean scores of this questionnaire were calculated for the variables assessed. Tobit regression was used to evaluate variation in these individuals. RESULTS Of the 60,202 interviewees, 6.03% (n = 3,636) reported diabetes mellitus. The disease was more frequent in female, older, widowed, obese and with incomplete elementary education. Depression symptoms were mild-to-moderately severe in 22% of the diabetics. The severity of current depressive symptoms was higher in individuals that were female (PHQ-9 mean = 3.35), older adults (PHQ-9 mean = 3.01), indigenous (PHQ-9 mean = 3.46), separated/divorced (PHQ-9 mean = 3.13), widowed (PHQ-9 mean = 3.39), obese (PHQ-9 mean = 3.13) and with incomplete primary education (PHQ-9 mean = 3.21). Higher severity of depressive symptoms was associated with the use of insulin and with coma (PHQ-9 mean = 8.32), limb amputation (PHQ-9 mean = 7.55), circulatory problems (PHQ-9 mean = 6.94), infarction (PHQ-9 mean = 6.83), diabetic foot (PHQ-9 mean = 6.62), and kidney problems (PHQ-9 mean = 6.68). The severity of current depressive symptoms was associated with diabetes severity and degree of limitation in activities of daily living (PHQ-9 mean = 10.62). CONCLUSIONS Interventions to improve depressive symptoms should be prioritized in people with diabetes are female, older adults, indigenous, widowed, separated/divorced, obese and with incomplete elementary education.