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  • Cross-cultural adaptation of discrimination and vigilance scales in ELSA-Brasil Original Articles

    Griep, Rosane Harter; Oliveira, Fernanda Esthefane Garrides; Aguiar, Odaleia Barbosa de; Moreno, Arlinda B.; Alves, Márcia Guimarães de Mello; Patrão, Ana Luisa; Fonseca, Maria de Jesus Mendes da; Chor, Dóra

    Abstract in Portuguese:

    RESUMO OBJETIVO Descrever o processo de adaptação transcultural para o uso no Brasil das escalas de discriminação no dia a dia (EDD) e vigilância intensificada (EVI), aplicadas no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). MÉTODOS Foram realizadas análises das equivalências conceitual, de itens e semântica conduzidas por um grupo de quatro epidemiologistas; avaliação da equivalência de mensuração (análise fatorial das estruturas configural, métrica e escalares, segundo características sociodemográficas) e a confiabilidade. Responderam à escala de discriminação 11.987 participantes e uma subamostra de 260 pessoas participaram do estudo teste-reteste. No caso da EVI, 8.916 pessoas responderam e 149 indivíduos no estudo teste-reteste. RESULTADOS As escalas apresentaram equivalências conceitual, de itens e semântica pertinentes no contexto brasileiro, além de adequada correspondência de significado referencial/denotativa de termos e também da geral/conotativa dos itens. A análise fatorial confirmatória da EDD revelou estrutura unidimensional, com correlações residuais entre dois pares de itens, apresentando invariância configural e métrica entre os quatro subgrupos avaliados. Identificou-se invariância escalar segundo sexo e faixa etária, mas não foi observada para recortes de raça/cor e escolaridade. A vigilância intensificada apresentou cargas baixas e resíduos altos, com indicadores de ajuste inadequados. Para os itens da escala de discriminação o coeficiente de concordância kappa ponderado (Kp) variou de 0,44 a 0,78, e o coeficiente de correlação intraclasse (CCI) foi 0,87. Para os itens da EVI, o Kp variou de 0,47 a 0,59 e o CCI foi 0,83. CONCLUSÕES Embora haja itens correlacionados, concluiu-se que a EDD é uma escala promissora para avaliar experiências de discriminação percebidas no cotidiano brasileiro. Entretanto, a EVI não apresentou equivalência de mensuração no formato atual.

    Abstract in English:

    ABSTRACT OBJECTIVE To describe the process of cross-cultural adaptation for the use in Brazil of the everyday discrimination scale (EDS) and the heightened vigilance scale (HVS) applied in the Longitudinal Study of Adult Health (ELSA-Brasil). METHODS Conceptual, item and semantic equivalence analyses were conducted by a group of four epidemiologists; evaluation of measurement equivalence (factorial analysis of configural, metric and scalar structures, according to sociodemographic characteristics) and reliability. A total of 11,987 participants responded to the discrimination scale, and a subsample of 260 people participated in the test-retest study. In the case of HVS, 8,916 people responded, while 149 individuals did so in the test-retest study. RESULTS The scales presented conceptual, item and semantic equivalence pertinent in the Brazilian context, in addition to adequate correspondence of referential/denotative meaning of terms and also of the general/connotative of the items. The confirmatory factor analysis of EDS revealed a unidimensional structure, with residual correlations between two pairs of items, presenting configural and metric invariance among the four subgroups evaluated. Scalar invariance was identified according to sex and age group, but it was not observed for race/color and education. Heightened vigilance showed low loads and high residuals, with inadequate adjustment indicators. For the items of the discrimination scale the weighted kappa coefficient (Kp) ranged from 0.44 to 0.78, and the intraclass correlation coefficient (ICC) was 0.87. For HVS items, the Kp ranged from 0.47 to 0.59 and the ICC was 0.83. CONCLUSIONS Although there are correlated items, it was concluded that the EDS is a promising scale to evaluate experiences of perceived discrimination in Brazilian daily life. However, the heightened vigilance scale did not present equivalence of measurement in the current format.
  • Characteristics associated with dietary patterns in Brazilian children under two years of age Original Articles

    Carvalho, Rumão Batista Nunes de; Louzada, Maria Laura da Costa; Rauber, Fernanda; Levy, Renata Bertazzi

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar padrões alimentares de crianças brasileiras menores de dois anos e verificar a sua associação com características sociodemográficas e de utilização de serviços de saúde. MÉTODOS Estudo transversal com dados da Pesquisa Nacional de Saúde (PNS) de 2013. A identificação dos padrões foi realizada em dois grupos etários por meio da análise fatorial por componentes principais e a correlação às características de interesse, testada por meio de modelos de regressão linear. RESULTADOS Em ambos os grupos foram identificados dois padrões alimentares: o primeiro foi caracterizado pelo consumo de alimentos in natura ou minimamente processado e o segundo marcado somente pelo consumo de alimentos ultraprocessados. A maior adesão das crianças entre seis e 11 meses ao primeiro padrão foi associada à maior renda familiar per capita, residência em área urbana e nas regiões mais desenvolvidas do país. Com 12 meses ou mais, a adesão foi relacionada com a raça/cor branca, maior renda familiar per capita, residência nas regiões mais desenvolvidas e realizar consultas de puericultura em serviços privados. No segundo padrão, a aderência entre os menores de um ano foi inversamente associada com raça/cor amarela ou indígena, residência na região Nordeste e realização de puericultura nos serviços públicos especializados ou nos privados. A partir dos 12 meses, a adesão foi diretamente associada com raça/cor preta ou parda e residência nas regiões mais desenvolvidas, e inversamente associada com residência na região Nordeste. CONCLUSÃO O estudo identificou dois padrões alimentares opostos em crianças brasileiras menores de dois anos, sendo que diferentes determinantes sociais modificam a chance de adesão a esses padrões.

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze the dietary patterns of Brazilian children under two years of age and assess their association with sociodemographic characteristics and health service use. METHODS This is a cross-sectional study with data from the 2013 National Health Survey (PNS). Patterns were found for two age groups by principal component analysis and their correlation with characteristics of interest was tested by linear regression models. RESULTS We found two dietary patterns for our groups. The first consisted of the consumption of fresh or minimally processed foods and the second, of ultra-processed foods. The greater adherence of children between six and 11 months to the first pattern was associated with higher per capita family income and urban residences in the most developed regions of Brazil. At 12 months or more, adherence related to white race/color, higher per capita family incomes, residence in more developed regions, and visits to private childcare. Adherence to the second pattern among children under one year of age was inversely associated with Yellow or Indigenous race/color, residence in the Brazilian Northeast, and childcare in specialized public or private services. At 12 months or more, greater adherence was directly associated with Black or Brown children who resided in more developed regions, and inversely associated with those living in the Brazilian Northeast. CONCLUSION We found two opposite dietary patterns in Brazilian children under two years of age and that several social determinants modify their chance of adhering to these patterns.
  • Bacterial vaginosis and cervical human papillomavirus infection in young and adult women: a systematic review and meta-analysis Review

    Martins, Bruno César Teodoro; Guimarães, Rafael Alves; Alves, Rosane Ribeiro Figueiredo; Saddi, Vera Aparecida

    Abstract in English:

    ABSTRACT OBJECTIVE To investigate the association between bacterial vaginosis and cervical human papillomavirus (HPV) infection in young and adult women. METHODS This systematic review and meta-analysis was based on the Prisma methodological guidelines. PubMed and Web of Science were searched using the following descriptors: “bacterial vaginosis and HPV”, in June 2019. Articles published from 2012 to 2019 were included. Inclusion criteria were original studies that investigated the association between bacterial vaginosis and cervical HPV infection; articles published in English, Spanish or Portuguese; studies conducted in young and adult, non-pregnant, non-HIV-infected women; studies that used the Nugent criteria for the diagnosis of bacterial vaginosis and studies in which the detection of HPV used the polymerase chain reaction technique. Assembled data, odds ratio (OR) and respective 95% confidence intervals (95%CI) were estimated for the association between bacterial vaginosis and cervical HPV infection using random-effects models. A bilateral value of p < 0.05 was considered statistically significant. RESULT Six studies were selected for analysis and demonstrated association between bacterial vaginosis and cervical HPV infection (OR = 2.68; 95%CI: 1.64–4.40; p < 0.001). CONCLUSION Bacterial vaginosis was considered a risk factor for cervical HPV infection, since women with bacterial vaginosis were more likely to be infected with HPV.
  • Violence in Quilombola women living in rural communities in Brazil Original Articles

    Luciano, Thaís Verly; Cislaghi, Beniamino; Miranda, Raquel Barbosa; Dias, Jerusa Araújo; Diaz-Bermudez, Ximena Pamela; Miranda, Angelica Espinosa

    Abstract in English:

    ABSTRACT OBJETIVE To estimate the prevalence of psychological, physical, and sexual violence perpetrated against women by their intimate partner (IP) in Quilombola communities located in Espírito Santo State, Brazil. METHODS The data is from a population-based cross-sectional study of Quilombola women conducted from 2017 to 2018. In-person interviews collected information on women’s sociodemographic characteristics, behaviors, and their experience of violence perpetrated by their IP. The analysis used chi-square test and hierarchical logistic regression. RESULTS 219 women (94.8% of the invited ones) agreed to participate in the study. 59.0% (95%CI: 5.25–65.5) reported psychological violence; 41% (95%CI: 34.5–47.5) physical violence; and 8.2% (95%CI: 4.6–11.8) sexual violence. Psychological violence was associated with having three or more sexual partners in life, when compared to those who had up to two partners (p = 0,009), and previous violence involving other people outside of family increased the chance of suffering psychological violence by an IP more than nine times (p ≤ 0.001). Regarding physical violence, the association with use of barrier contraception (p = 0.031) and having a partner with other sexual partners (p = 0.024) were protective factors for IP violence. Having 3 or more sexual partners in the last 12 months (p = 0.006), partner using illicit drugs (p = 0,006), and alcoholism in the family (p = 0,001), increased the chance of suffer physical violence by the partner. Sexual violence perpetrated by the IP was associated with miscarriage (p = 0.016), partner using drugs (p = 0.020), and gynecological symptoms (p = 0.045). CONCLUSIONS These results showed the high frequency of intimate partner violence in Quilombola women and highlight the importance of reducing social and race inequities for interrupting the culture of violence against women.
  • The habit of drinking and driving in Brazil: National Survey of Health 2013 and 2019 Original Articles

    Ribeiro, Lucas Sisinno; Damacena, Giseli Nogueira; Souza Junior, Paulo Roberto Borges de; Szwarcwald, Célia Landmann

    Abstract in Portuguese:

    RESUMO OBJETIVO Investigar os fatores associados ao hábito de beber e dirigir, bem como estimar as variações nas prevalências desse comportamento entre os anos de 2013 e 2019, por meio das informações das duas edições da Pesquisa Nacional de Saúde (PNS). MÉTODOS A PNS é um estudo transversal, de âmbito nacional e base domiciliar. Nos anos de 2013 e 2019, foram entrevistados, respectivamente, 60.202 e 85.854 indivíduos. Para investigar a associação entre o indicador “beber e dirigir” e as variáveis do estudo, as razões de chances (RC) brutas e ajustadas foram estimadas por meio de modelos de regressão logística. Para a comparação das prevalências entre os anos estudados, foi utilizado o teste Qui-Quadrado de Pearson ajustado pela correção de Rao-Scott (que leva em consideração o efeito do plano de amostragem) e convertido em uma estatística F, testada no nível de significância de 5%. RESULTADOS A prevalência do hábito de beber e dirigir foi maior entre os homens no ano de 2013 (27,4%; IC95% 25,6–29,3%) e no ano de 2019 (20,5%; IC95% 19,4–21,7%) do que entre as mulheres (11,9%; IC95% 9,9–14,2% e 7,2%; IC95% 6,7–9,0%, respectivamente). Estimativas significativamente mais altas foram apresentadas por pessoas de 30 anos a 39 anos, que vivem sem companheiro(a), residentes em áreas rurais e condutores de motocicleta. Maiores prevalências de beber e dirigir foram encontradas entre homens que possuem maior rendimento. Entre os anos de 2013 e 2019, foi observado um decréscimo significativo no ato de beber e dirigir. Quanto ao envolvimento em acidentes de trânsito, as RC foram significativas (p < 0,01) nos anos estudados em ambos os sexos. DISCUSSÃO Os resultados mostram a necessidade de dar continuidade às políticas de fiscalização de alcoolemia e educação no trânsito, com ações específicas dirigidas às áreas rurais e aos condutores de motocicletas.

    Abstract in English:

    ABSTRACT OBJECTIVE To assess factors associated with the habit of drinking and driving and estimating the variations in the prevalence of this behavior in 2013 and 2019, considering information from the two editions of the Pesquisa Nacional de Saúde (PNS – National Survey of Health). METHODS PNS is a nationwide cross-sectional home-based study. In 2013 and 2019, 60,202 and 85,854 individuals were interviewed, respectively. To assess the association between the indicator “drinking and driving” and the study variables, crude and adjusted odds ratios (ORs) were estimated using logistic regression models. To compare the prevalence between the studied years, a Pearson’s chi-squared test adjusted by the Rao-Scott correction (which considers the effect of the sampling plan) and converted into an F statistic, tested at a 5% significance level, was used. RESULTS The prevalence of drinking and driving was higher among men in 2013 (27.4%; 95%CI 25.6–29.3%) and 2019 (20.5%; 95%CI 19.4–21.7%) than among women (11.9%; 95%CI 9.9–14.2% and 7.2%; 95%CI 6.7–9.0%, respectively). Inidviduals aged 30 to 39, who lived without a partner, in rural areas, and were motorcycle drivers had significantly higher estimates. Men with higher income had higher prevalence of drinking and driving. From 2013 to 2019, the act of drinking and driving significantly decreased. Regarding traffic accidents, ORs were significant (p < 0.01) in the studied years for both men and women. DISCUSSION Results show the need to continue policies to monitor blood alcohol level and traffic education, with specific actions directed to rural areas and motorcycle drivers.
  • Erratum

  • Epidemiology of tobacco use and nicotine dependence in truck drivers Original Articles

    Fernandes, Inaina Lara; Guimarães, Rafael Alves; Lucchese, Roselma; Vera, Ivânia; Brito, Rodolfo Pereira de; Ramos, Camila Borges; Marinho, Tamíris Augusto; Nunes, Patrícia Silva; Diniz-Pinto, Henrique Senna; Amorim, Thiago Aquino

    Abstract in English:

    ABSTRACT OBJECTIVE To investigate the epidemiology of tobacco use and nicotine dependence in a sample of truck drivers in Brazil. METHODS Between 2015 and 2016, a cross-sectional study was conducted on 624 truck drivers who operate on the BR-050 highway in Brazil. Participants were interviewed about sociodemographic data, occupational characteristics, mental health, behavioral data, and tobacco use. Then, the Fagerstrom test for nicotine dependence (FTND) was used to verify nicotine dependence in smoking truck drivers. Logistic regression and linear regression were also used to verify factors associated with tobacco use in the previous 30 days and nicotine dependence scores, respectively. RESULTS The prevalence of tobacco use among truck drivers was 21.1% (n = 132;95%CI: 18.1–24.5). Of the total number of smokers who responded to the FTND (n = 118; 89.4%), most had high/very high nicotinic dependence (68.6%; 95%CI: 59.8–76.3). Tobacco use was associated with absence of religion (adjusted odds ratio [AOR]: 2.60; 95%CI: 1.35–5.01), employment relationship of the contract (AOR = 1.98; 95%CI: 1.26–3.13); > 12 hours daily working time (AOR = 1.80; 95%CI: 1.09–2.98) and alcohol use in the previous 30 days (AOR = 2.92; 95%CI: 1.86–4.57). Irregular physical activity was associated with higher scores of nicotine dependence (β = 1.87; 95%CI: 0.55–3.19). CONCLUSION The results showed a high prevalence of tobacco use and high/very high nicotine dependence among the truck drivers.
  • Major depressive episode in hospital workers during the Covid-19 pandemic in Brazil Original Articles

    Flesch, Betina Daniele; Szortyka, Ana Laura Sica Cruzeiro; Carvalho, Maitê Peres de; Goularte, Laura Moreira; Delpino, Felipe Mendes; Fassa, Anaclaudia Gastal

    Abstract in English:

    ABSTRACT OBJECTIVES To estimate prevalence and factors associated with major depressive episode (MDE), emphasizing occupational aspects, in workers of a public teaching hospital that is a reference for Covid-19 treatment. METHODS A cross-sectional study was carried out between October and December 2020, after the first peak of the pandemic, interviewing 1,155 workers. The prevalence of MDE was estimated using the Patient Health Questionnaire (PHQ-9) algorithm. Multivariate hierarchical analysis was conducted using Poisson regression to assess associated factors. RESULTS MDE prevalence was 15.3% (95%CI: 13.3–17.5) and was higher among young, white and female workers, those with a family history of depression, resident professionals, nursing professionals, workers who were exposed to three or more situations of moral dilemma, and those who had to put off a physiological need until later. Having a risk factor for Covid-19, being a smoker and being physically inactive were also positively associated with MDE. CONCLUSIONS The study points to the considerable prevalence of MDE among tertiary health care workers; reviewing work processes is essential to reduce occupational stress and minimize the effects of the pandemic on mental health, preventing those problems from becoming chronic.
  • Arterial hypertension and associated factors: National Health Survey, 2019 Original Articles

    Malta, Deborah Carvalho; Bernal, Regina Tomie Ivata; Ribeiro, Edmar Geraldo; Moreira, Alexandra Dias; Felisbino-Mendes, Mariana Santos; Velásquez-Meléndez, Jorge Gustavo

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar os fatores associados à hipertensão arterial autorreferida, bem como sua prevalência, na população de adultos brasileiros. MÉTODOS Foram analisados dados de 88.531 indivíduos de 18 anos ou mais que responderam à Pesquisa Nacional de Saúde de 2019. O desfecho estudado foi a hipertensão arterial autorreferida. Como exposições, foram consideradas variáveis sociodemográficas, condições clínicas e de estilo de vida. Para verificar os fatores associados à prevalência, usou-se como medida de associação a razão de prevalência (RP) bruta e ajustada por sexo, idade e escolaridade, obtidas por meio da Regressão de Poisson com variância robusta. RESULTADOS A prevalência da hipertensão arterial autorreferida foi de 23,9% (IC95% 23,4–24,4). Ao ajustar por idade, sexo e escolaridade, as Razões de Prevalência ajustadas (RPaj) foram mais elevadas entre: auto avaliação de saúde regular (RPaj = 1,6; IC95% 1,5–1,6) e ruim (RPaj = 1,7; IC95% 1,6–1,8); autorreferência a doença do coração (RPaj = 1,7; IC95% 1,6–1,7), diabetes (RPaj = 1,7; IC95% 1,6–1,8), colesterol elevado (RPaj = 1,6; IC95% 1,6–1,7), sobrepeso (RPaj = 1,4; IC95% 1,4–1,5) e obesidade (RPaj = 2,0; IC95% 1,9–2,1); consumo elevado de sal (RPaj = 1,1; IC95% 1,0–1,1); entre ex-fumantes (RPaj = 1,1; IC95% 1,1–1,2) e menor entre fumantes (RPaj = 0,9; IC95% 0,8–0,9) e consumo de alimentos ultraprocessados (RPaj = 0,9; IC95% 0,8–0,9). CONCLUSÃO Um quarto da população adulta brasileira afirma ter hipertensão arterial, de forma mais prevalente entre as mulheres e associada às maiores faixas etárias, cor da pele/raça preta, parda e outras, baixa escolaridade, consumo elevado de sal, ex-tabagismo, presença de comorbidades e pior autoavaliação de saúde.

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze the factors associated with self-reported arterial hypertension, as well as its prevalence in the Brazilian adult population. METHODS Data from 88,531 individuals aged 18 years or older who responded to the 2019 National Health Survey were analyzed. The outcome studied was self-reported arterial hypertension. Sociodemographic variables and clinical and lifestyle conditions were considered as exposures. The prevalence ratio (PR), crude and adjusted for sex, age, and schooling was used as a measure of association to verify the factors related to its prevalence, obtained by Poisson regression with robust variance. RESULTS The prevalence of self-reported arterial hypertension was of 23.9% (95%CI: 23.4–24.4). When adjusting for age, sex, and schooling, the adjusted Prevalence Ratios (APR) were higher among: regular health self-assessment (APR = 1.6; 95%CI: 1.5–1.6) and bad health self-assessment (APR = 1.7; 95%CI: 1.6–1.8); self-reference to heart disease (APR = 1.7; 95%CI: 1.6–1.7), diabetes (APR = 1.7; 95%CI: 1.6–1.8), high cholesterol (APR = 1.6; 95%CI: 1.6–1.7), overweight (APR = 1.4; 95%CI: 1.4–1.5), and obesity (APR = 2.0; 95%CI: 1.9–2.1); high salt intake (APR = 1.1; 95%CI: 1.0–1.1); higher among former smokers (APR = 1.1; 95%CI: 1.1–1.2) and lower among smokers (APR = 0.9; 95%CI: 0.8–0.9); and consumption of ultra-processed foods (APR = 0.9; 95%CI: 0.8–0.9). CONCLUSION A quarter of the Brazilian adult population claims to have arterial hypertension, more prevalent among women and associated with older age groups, Black, mixed-race, and others, low schooling, high salt intake, former smoking, presence of comorbidities, and worse health self-assessment.
  • Distortions of parliamentary amendments to the equitable allocation of federal resources to the PAB Original Articles

    Vieira, Fabiola Sulpino; Lima, Luciana Dias de

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar as implicações das emendas parlamentares (EP) para o modelo de alocação equitativa de recursos do Piso da Atenção Básica Fixo (PAB-Fixo) aos municípios no período de 2015 a 2019. MÉTODOS Realizou-se um estudo descritivo e exploratório da alocação de recursos federais para o PAB-Fixo e para incremento ao PAB por emenda parlamentar. Os municípios foram classificados em quatro grupos, segundo graus de vulnerabilidade socioeconômica definidos pelo Ministério da Saúde para destinação de recursos do PAB-Fixo. Os repasses do ministério por emenda parlamentar foram identificados, analisando-se as proporções de municípios beneficiados em cada grupo por recursos alocados do PAB-Fixo e do incremento ao piso por EP. RESULTADOS Verificou-se redução dos recursos alocados ao PAB-Fixo (de R$ 6,04 bilhões para R$ 5,51 bilhões, -8,8%) e aumento do incremento ao PAB por emenda parlamentar (de R$ 95,06 milhões para R$ 5,58 bilhões, 5.767%) entre 2015 e 2019. A participação dos municípios por grupo dos que foram favorecidos por EP foi semelhante à dos municípios do PAB-Fixo. Na proporção de recursos por emendas, os municípios do grupo I (mais vulneráveis) tiveram maior participação e os do grupo IV, menor participação, se comparada à alocação do PAB-Fixo. A distribuição de recursos por emenda parlamentar não contemplou todos os municípios, mesmo aqueles mais vulneráveis, pertencentes aos grupos I e II. Houve grande desigualdade de recursos per capita segundo os grupos de municípios. CONCLUSÃO As EP distorceram o modelo de alocação equitativa de recursos proposto pelo Ministério da Saúde para o PAB-Fixo, ao destinar recursos em proporção muito maior para os municípios do grupo I e muito menor para os do grupo IV, o que está em desacordo com esse modelo, além disso essa distribuição por emendas não beneficia a todos os municípios, nem mesmo aos mais vulneráveis.

    Abstract in English:

    ABSTRACT OBJECTIVE Analyze the implications of parliamentary amendments (EP) for the model of equitable allocation of resources from the Fixed Primary Care Minimum (PAB-Fixo) to municipalities in the period from 2015 to 2019. METHODS A descriptive and exploratory study was conducted on allocating federal resources to the PAB-Fixo and on the increment in the PAB by parliamentary amendment. The municipalities were classified into four groups according to degrees of socioeconomic vulnerability defined by the Ministry of Health for the allocation of PAB-Fixo resources. The transfers from the Ministry by parliamentary amendment were identified. The proportions of municipalities benefiting per group were analyzed by resources allocated from the PAB-Fixo and increment to the minimum by EP. RESULTS There were reduced resources allocated to the PAB-Fixo (from R$ 6.04 billion to R$ 5.51 billion, -8.8%) and increased increment to PAB by parliamentary amendment (from R$ 95.06 million to R$ 5.58 billion, 5.767%) between 2015 and 2019. The participation of municipalities by the group of those favored by EP was similar to that in the PAB-Fixo. In the proportion of resources for amendments, the municipalities of group I (most vulnerable) had more participation, and those of group IV had less participation if compared to the allocation of the PAB-Fixo. The distribution of resources by the parliamentary amendment did not cover all municipalities, even the most vulnerable ones, i.e., belonging to groups I and II. There was great inequality of resources per capita according to the groups of municipalities. CONCLUSION The EP distorted the model of equitable allocation of resources proposed by the Ministry of Health for the PAB-Fixo, by allocating resources in a much more significant proportion to the municipalities of group I and much less to those of group IV, which is in disagreement with this model. Furthermore, this distribution by amendments does not benefit all municipalities, not even the most vulnerable.
  • Factors associated with bariatric surgery rates in federative units in Brazil Original Articles

    Silva, Ivan Augusto Cecilio e; Favoretto, Cassia Kely; Russo, Leticia Xander

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar os fatores socioeconômicos, demográficos e de gestão em saúde associados às taxas de cirurgias bariátricas realizadas pelo Sistema Único de Saúde (SUS) nas unidades federativas (UF) do Brasil. MÉTODOS Descrição e análise da taxa de cirurgias bariátricas (por 100 mil habitantes) realizadas pelo SUS em adultos de 18 a 65 anos, nas 27 unidades federativas do Brasil, entre 2008 e 2018; para isso, utilizou-se a metodologia econométrica de painel de contagem com distribuição binomial negativa (population-averaged, efeitos fixos e efeitos aleatórios). Investigou-se, também, os fatores socioeconômicos e demográficos, considerando o produto interno bruto (PIB) real per capita, a média de anos de estudo de adultos e a expectativa de vida ao nascer, e os da gestão em saúde, tendo em vista a cobertura da atenção básica, a taxa de cirurgiões de aparelho digestivo e a taxa de hospitais credenciados na assistência de alta complexidade (AAC) ao indivíduo obeso no SUS. RESULTADOS Em termos regionais, verificou-se grande disparidade na realização de cirurgias bariátricas públicas no Brasil ao longo do período analisado: os procedimentos estão concentrados nas regiões Sul e Sudeste, sendo escassos na região Norte. Além disso, encontrou-se uma relação positiva entre a taxa de cirurgias bariátricas e a expectativa de vida, a taxa de cirurgiões de aparelho digestivo e a taxa de hospitais credenciados na assistência de alta complexidade; havendo, porém, uma associação negativa em relação ao PIB real per capita, a média de anos de estudo de adultos e a cobertura da atenção básica. CONCLUSÕES No período analisado, o índice de cirurgias bariátricas foi explicado pelos fatores investigados. Portanto, mostrou-se de fundamental importância a formação de profissionais de saúde especializados, o credenciamento de hospitais conforme o marco legal, as ações preventivas da atenção básica, e os fatores socioeconômicos e demográficos, condicionantes da oferta do tratamento cirúrgico pelo Sistema Único de Saúde. Sendo assim, todos fatores relevantes para a formulação de políticas públicas nessa área.

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze the socioeconomic, demographic and health management factors associated with bariatric surgery rates performed by the Brazilian Unified Health System (SUS) in the federative units in Brazil. METHODS Description and analysis of bariatric surgeries rates (per 100,000 inhabitants) performed by SUS in adults from 18 to 65 years old, in the 27 federative units of Brazil, between 2008 and 2018; thus, the econometric methodology of count panel with negative binomial distribution (population-averaged, fixed effects and random effects) was used. Socioeconomic and demographic factors were also investigated, considering the real gross domestic product per capita, the average years of study of adults and life expectancy at birth, and those of health management, given the primary health care coverage, the rate of digestive system surgeons and the rate of hospitals accredited in high complexity care to patients with obesity in the SUS. RESULTS In regional terms, the performance of public bariatric surgeries in Brazil over the period analyzed suffered a great disparity; the procedures happen mostly in the South and Southeast regions, and scarcely in the North region. Moreover, we found a positive relationship between the rate of bariatric surgeries and life expectancy, the rate of digestive system surgeons and the rate of hospitals accredited in high complexity care; however, the average number of years of adult study and coverage of primary health care is a negative association regarding real gross domestic product per capita. CONCLUSION In the period analyzed, the investigated factors explained the rate of bariatric surgeries. Therefore, to train specialized health professionals, the accreditation of hospitals according to the legal framework, preventive actions of primary care, and socioeconomic and demographic factors, conditioning for the offer of surgical treatment by the SUS were crucial. Thus, these are all relevant factors for the formulation of public policies in this area.
  • An incomplete step in the right direction: Peru’s National Institute of Health establishes cost-effectiveness threshold

    Saldarriaga, Enrique M.
  • Gestational age, intrauterine growth and body composition at 11 years of age Original Articles

    Bortolotto, Caroline Cardozo; Santos, Iná da Silva dos; Vaz, Juliana dos Santos; Matijasevich, Alicia

    Abstract in Portuguese:

    RESUMO OBJETIVO Avaliar a associação da idade gestacional (IG) e crescimento intrauterino com a composição corporal aos 11 anos de idade. MÉTODO Análise de dados da coorte de nascimentos de Pelotas de 2004, cujos desfechos foram massa gorda (MG, kg), índice de massa gorda (IMG, kg/m2), massa livre de gordura (MLG, kg), índice de massa livre de gordura (IMLG, kg/m2) – medidos por pletismografia por deslocamento de ar –, e índice de massa corporal para idade (IMC/Idade, escore-Z). Sendo as exposições de interesse o índice gestacional (IG) de nascidos com menos de 33 semanas, de 34 a 36 e de 37 a 41, e crescimento intrauterino categorizado em pequeno para a idade gestacional (PIG), adequado (AIG) e grande (GIG). Para comparar médias, utilizou-se análise de variância e, para avaliar a força de associação, regressão linear. As análises foram ajustadas de acordo com variáveis coletadas ao nascer, como renda familiar mensal, características maternas – escolaridade, idade, índice de massa corporal (IMC) pré-gestacional, ganho de peso na gestação, tabagismo na gestação, tipo de parto e paridade – e características dos adolescentes – cor da pele e peso ao nascer. Para análise, o MG e o IMG sofreram transformação logarítmica devido a assimetria dos dados. RESULTADOS Foram analisados 3.401 adolescentes, entre meninos e meninas nascidos com menos de 33 semanas, com médias de MG e MLG menores que as dos nascidos(as) a termo. Porém, nas análises ajustadas, não houve associação entre IG e qualquer um dos desfechos em ambos os sexos. Meninos GIG apresentaram IMG 10,5% maior (p = 0,026) e +0,3 escore-Z de IMC/Idade (p = 0,019) em relação aos AIG, e meninas GIG apresentaram +0,3 kg/m2 de IMLG (p = 0,039) do que as AIG. CONCLUSÃO A IG não se associou à composição corporal aos 11 anos. Entretanto, meninos GIG apresentaram maiores IMG e escore-Z de IMC/Idade e meninas GIG, maior IMLG, quando comparados aos AIG.

    Abstract in English:

    ABSTRACT OBJETIVE To assess the association of gestational age (GA) and intrauterine growth with body composition at 11 years of age. METHOD Analysis of data from the 2004 Pelotas birth cohort, whose outcomes were fat mass (FM, kg), fat mass index (FMI, kg/m2), fat-free mass (FFM, kg), fat-free mass index (FFMI, kg/m2) – measured by air displacement plethysmography – and body mass index for age (BMI/age, Z-score). The exposures of interest were the gestational index (GA) of infants born at less than 33 weeks, from 34 to 36 and from 37 to 41, and intrauterine growth categorized as small (SGA), adequate (AGA) and large (LGA) for gestational age. Analysis of variance was used to compare means and linear regression was used to assess the strength of association. The analyses were adjusted according to variables collected at birth, such as monthly family income, maternal characteristics – education, age, pre-gestational body mass index (BMI), weight gain during pregnancy, smoking during pregnancy, type of delivery, and parity – and adolescent characteristics – skin color and birth weight. For analysis, FM and FMI underwent logarithmic transformation due to data asymmetry. RESULTS A total of 3,401 adolescents were analyzed, including boys and girls born at less than 33 weeks, with lower FM and FFM means than those born at term. However, in the adjusted analyses, there was no association between GA and any of the outcomes in either sex. LGA boys had a 10.5% higher FMI (p = 0.026) and +0.3 BMI/age Z-score (p = 0.019) as compared to AGA boys, and LGA girls had +0.3 kg/m 2 of FFMI (p = 0.039) than AGA girls. CONCLUSION GA was not associated with body composition at 11 years of age. However, LGA boys had higher BMI and BMI/age Z-score, and LGA girls had higher FFMI than AGA girls.
  • Follow-up of children diagnosed with deafness in a neonatal hearing screening program in Manaus Original Articles

    Botelho, João Bosco Lopes; Carvalho, Diego Monteiro de; Santos-Melo, Giane Zupellari dos; Cardoso Neto, José; Nascimento, Samuel Machado do; Figueiredo, Wenberger Lanza Daniel de; Lacerda, Larissa Abreu; Nogueira, Kristian Holanda

    Abstract in Portuguese:

    RESUMO OBJETIVO Avaliar o seguimento das crianças com diagnóstico de surdez na triagem auditiva neonatal e fatores de risco para deficiência auditiva. MÉTODOS Estudo quantitativo, transversal e retrospectivo para avaliação de fatores associados à perda auditiva e o seguimento dos casos de crianças diagnosticadas com disfunção audiológica, por meio da análise de prontuários eletrônicos de 5.305 crianças encaminhadas a um Centro Especializado em Reabilitação Tipo I, no período de janeiro/2016 a fevereiro/2020, na cidade de Manaus, Amazonas. O estudo estatístico utilizou o teste qui-quadrado de Pearson e por regressão logística binária nos quais foram obtidos odds ratio com intervalos de confiabilidade de 95%. RESULTADOS Das 5.305 crianças encaminhadas para realização do reteste da orelhinha, 366 (6,9%) falharam no reteste. Prosseguiram no estudo as crianças com diagnóstico de perda auditiva neurossensorial, totalizando 265 (72,4%). Permanecendo, no final da pesquisa, apenas 58 (21,9%) crianças, destas 39 receberam aparelho auditivo até o presente estudo; e 16 (41%) já tinham indicação cirúrgica para implante coclear, sendo que apenas três (18,7%) haviam realizado a cirurgia. Dentre os fatores de risco para deficiência auditiva encontramos 2,6 vezes mais chance de falha no reteste da orelhinha naquelas crianças que tinham história familiar de perda auditiva e internação em UTI. CONCLUSÕES Embora o fluxo de triagem alcance boa parte dos nascidos vivos, as taxas de evasão durante o processo são altas, portanto, as características socioeconômicas e geográficas de regiões como a Amazônia devem ser consideradas como fatores relevantes à evasão dos programas de reabilitação dessas crianças. Foi possível identificar que a internação em UTI neonatal e o histórico familiar de perda auditiva presentes nas investigações compõem os principais e mais importantes fatores para alteração dos retestes da orelhinha.

    Abstract in English:

    ABSTRACT OBJECTIVE To evaluate the follow-up of children diagnosed with deafness in neonatal hearing screening and risk factors for hearing loss. METHODS Quantitative, cross-sectional, and retrospective study to evaluate factors associated with hearing loss and the follow-up of cases of children diagnosed with audiological dysfunction, by analyzing electronic medical records of 5,305 children referred to a Specialized Center in Type I Rehabilitation, from January/2016 to February/2020, in the city of Manaus, Amazonas. The statistical study used Pearson’s chi-square test and binary logistic regression in which odds ratio scans were obtained with reliability intervals of 95%. RESULTS Of the 5,305 children referred for the otoacoustic emission retest, 366 (6.9%) failed the retest. Children diagnosed with sensorineural hearing loss continued in the study, totaling 265 (72.4%). Only 58 (21.9%) children continued in the study to its end, of these 39 had received hearing aids at that point; and 16 (41%) had surgical indication for cochlear implants, of which only 3 (18.7%) had undergone surgery. Among the risk factors for hearing loss, we found 2.6 times more chance of failure in the otoacoustic emissions retest in those children who had a family history of hearing loss and ICU stay. CONCLUSION Although the screening flow reaches a large part of live births, the dropout rates during the process are high, therefore, the socioeconomic and geographic characteristics of regions such as the Amazon should be considered as relevant factors to the evasion of rehabilitation programs of these children. Hospitalization in the neonatal ICU and family history of hearing loss in the investigations could be identified as the main and most important factors for alteration of the otoacoustic emissions retests.
  • Treatments used by chronic obstructive pulmonary disease patients in Brazil: National Survey of Health, 2013 Original Articles

    Marques, Gabriela Ávila; Oliveira, Paula Duarte de; Montzel, Marina; Menezes, Ana Maria Baptista; Malta, Deborah Carvalho; Sardinha, Luciana Monteiro Vasconcelos; Wehrmeister, Fernando César

    Abstract in Portuguese:

    RESUMO OBJETIVO Estimar a prevalência dos tratamentos utilizados para o manejo da doença pulmonar obstrutiva crônica (DPOC) na população adulta brasileira. MÉTODOS Estudo transversal de base populacional com dados oriundos da Pesquisa Nacional de Saúde de 2013, incluindo indivíduos com 40 anos ou mais, com diagnóstico médico autorreferido de DPOC, bronquite crônica e/ou enfisema, os quais foram questionados sobre tratamentos utilizados para o manejo da doença. RESULTADOS Foram entrevistados 60.202 adultos, dos quais 636 tinham 40 ou mais anos de idade e haviam referido diagnóstico médico de DPOC, enfisema ou bronquite crônica. Menos da metade (49,4%) da população diagnosticada relatou utilizar algum tipo de tratamento, havendo diferenças quanto à macrorregião do país (Sul 53,8% – Nordeste 41,2%, p = 0,007). O tratamento medicamentoso foi o mais referido e portadores de enfisema apresentaram a maior proporção de mais de um tipo de tratamento utilizado. Entre os indivíduos que declararam ter apenas bronquite crônica, 55,1% (IC95% 48,7–61,4) usavam medicamento, 4,7% (IC95% 2,6–8,3) realizavam fisioterapia e 6,0% (IC95% 3,6–9,9) oxigenoterapia. Por outro lado, entre os enfisematosos, 44,1% (IC95% 36,8–51,7) realizavam tratamento medicamentoso, 8,8% (IC95% 5,4–14,2) fisioterapia e 10,0% (IC95% 6,3–15,6) oxigenoterapia. CONCLUSÕES As prevalências de tratamentos para o manejo da DPOC estavam aquém do ideal em 2013. O medicamentoso foi o principal tipo de tratamento, seguido de oxigenoterapia e fisioterapia.

    Abstract in English:

    ABSTRACT OBJECTIVE To estimate the prevalence of treatments used for the management of chronic obstructive pulmonary disease (COPD) in the Brazilian adult population. METHODS A population-based cross-sectional study with data from the 2013 Brazilian National Survey of Health, including individuals aged 40 years or older, with a self-reported medical diagnosis of COPD, chronic bronchitis and/or emphysema, who were asked about treatments used for disease management. RESULTS A total of 60,202 adults were interviewed, of which 636 were 40 years of age or older and had reported a medical diagnosis of COPD, emphysema, or chronic bronchitis. Less than half (49.4%) of the diagnosed population reported using some type of treatment, with differences regarding the macro-region of the country (South 53.8% – Northeast 41.2%, p = 0.007). Pharmacological treatment was the most reported, and emphysema patients had the highest proportion of those undergoing more than one type of treatment. Among the individuals who reported having only chronic bronchitis, 55.1% (95%CI: 48.7–61.4) used medication, 4.7% (95%CI: 2.6–8.3) underwent physical therapy, and 6.0% (95%CI: 3.6–9.9) oxygen therapy. On the other hand, among the emphysema patients, 44.1% (95%CI: 36.8–51.7) underwent drug treatment, 8.8% (95%CI: 5.4–14.2) physical therapy, and 10.0% (95%CI: 6.3–15.6) oxygen therapy. CONCLUSION The prevalence of treatments for COPD management was below ideal in 2013. The pharmacological treatment was the main type of treatment, followed by oxygen therapy and physical therapy.
  • Perception of discrimination against immigrants compared to Chilean-born and its relationship with access to services and health outcomes Original Articles

    Oyarte, Marcela; Cabieses, Báltica; Espinoza, Manuel; Valenzuela, María Teresa; Delgado, Iris

    Abstract in Spanish:

    RESUMEN OBJETIVOS Comparar la autopercepción de discriminación entre inmigrantes y locales en Chile y analizar la relación entre inmigración y discriminación percibida e inmigración, discriminación y resultados de salud, ajustando por características sociodemográficas y capital social. MÉTODOS Estudio transversal, utilizando encuesta poblacional (CASEN2017). Se seleccionaron 2.409 inmigrantes (representativos de N = 291.270) y 67.857 locales (representativos de N = 5.438.036) mayores de 18 años encuestados. Se estimaron modelos de regresión logística, considerando la muestra compleja, con discriminación, salud autoevaluada, tratamiento médico, pertenencia al sistema de salud, seguros complementarios de salud, consulta médica y problemas al consultar como variables dependientes, inmigración y discriminación como variables de exposición principal, y capital social y variables sociodemográficas como covariables de los modelos. RESULTADOS Inmigrantes tuvieron mayor posibilidad de percibir discriminación en general comparado con locales (OR = 2,31; IC95% 1,9–2,9). Sin embargo, esto no ocurre para todos los motivos específicos de discriminación; color de piel y apariencia física fueron las causas de discriminación más frecuentes en inmigrantes. La interacción entre inmigración y discriminación se relacionó significativamente con peores resultados de salud autoevaluada y tratamiento por patologías, en desfavor de los inmigrantes discriminados. Tanto en locales como en inmigrantes la discriminación no se asoció con resultados de acceso a atención en salud, excepto problemas durante la consulta en locales (OR = 1,61; IC95% 1,4–1,8). CONCLUSIONES En Chile, las experiencias de discriminación se entrelazan con otras formas de rechazo y exclusión social, por lo cual es urgente concientizar a la población para prevenir estas prácticas discriminatorias, sobre todo en la atención en salud y lugares de uso cotidiano. Abordar la discriminación es indispensable para lograr impactar en variables intermedias y resultados de salud. La extensión de los resultados a toda la población inmigrante podría ser de amplia utilidad para profundizar la problemática y mejorar las estimaciones realizadas.

    Abstract in English:

    ABSTRACT OBJECTIVES Compare self-perceived discrimination between immigrants and locals in Chile and analyze the relationship between immigration and perceived discrimination and immigration, discrimination and health outcomes, adjusting for sociodemographic characteristics and social capital. METHODS Cross-sectional study, using population-based survey (CASEN2017). We selected 2,409 immigrants (representative of N = 291,270) and 67,857 locals (representative of N = 5,438,036) over 18 years of age surveyed. We estimated logistic regression models, considering the complex sample, with discrimination, self-rated health, medical treatment, healthcare system membership, complementary health insurance, medical consultation and problems when consulting as dependent variables, immigration and discrimination as main exposure variables, and social capital and sociodemographic variables as covariates of the models. RESULTS Immigrants were more likely to perceive discrimination in general compared to locals (OR = 2.31; 95%CI: 1.9-2.9). However, this does not occur for all specific reasons for discrimination; skin color and physical appearance were the most frequent causes of discrimination in immigrants. The interaction between immigration and discrimination was significantly related to worse self-rated health outcomes and treatment for pathologies, disfavoring discrimination against immigrants. In both locals and immigrants, discrimination was not associated with health care access outcomes, except for problems during consultation in locals (OR = 1.61; 95%CI 1.4-1.8). CONCLUSIONS In Chile, experiences of discrimination are intertwined with other forms of rejection and social exclusion, so it is urgent to raise awareness among the population to prevent these discriminatory practices, especially in health care and daily use places. It is essential to address discrimination in order to have an impact on intermediate variables and health outcomes. The extension of the results to the entire immigrant population could be very useful to deepen the problem and improve the estimates made.
  • Instruments to assess adherence to medication in people living with HIV: a scoping review Review

    Santos, André Pereira dos; Cordeiro, Jéssica Fernanda Corrêa; Fracarolli, Isabela Fernanda Larios; Gomide, Euripedes Barsanulfo Gonçalves; Andrade, Denise de

    Abstract in Portuguese:

    RESUMO OBJETIVO Compilar os instrumentos validados no Brasil para avaliação da adesão de pessoas vivendo com HIV à terapia antirretroviral. MÉTODOS Revisão de escopo, utilizando as bases de dados Web of Science, Scopus, Medline (via PubMed), Embase, BDENF, CINAHL e Lilacs. Em complementação, os servidores Preprints bioRxiv, Google Scholar e OpenGrey foram verificados. Para a busca, não houve restrição de idioma e considerou artigos publicados a partir do ano de 1996. RESULTADOS Três publicações foram incluídas na síntese qualitativa. Os instrumentos identificados foram o “Questionário para Avaliação da Adesão ao Tratamento Antirretroviral”, desenvolvido em Porto Alegre (RS) e publicado em 2007; a “Escala de autoeficácia para adesão ao tratamento antirretroviral em crianças e adolescentes com HIV/Aids”, desenvolvida em São Paulo (SP) e publicada em 2008; e o “WebAd-Q, um instrumento de autorrelato para monitorar a adesão à terapia antirretroviral em serviços de HIV/Aids no Brasil”, desenvolvido em São Bernardo do Campo (SP) e publicado em 2018. Os instrumentos foram validados no Brasil e apresentaram valores estatisticamente aceitáveis para as qualidades psicométricas. CONCLUSÃO Os instrumentos para avaliar a adesão de pessoas vivendo com HIV à terapia antirretroviral são estratégias validadas para o contexto do Brasil. Todavia há que se expandir a (re)utilização em diferentes cenários e contextos da nação. A utilização desses instrumentos por profissionais da saúde pode melhorar a compreensão dos fatores que atuam negativa e positivamente na adesão à terapia antirretroviral, e a proposição de estratégias com o objetivo de consolidar a boa adesão e intervir no tratamento das pessoas com baixo engajamento terapêutico.

    Abstract in English:

    ABSTRACT OBJECTIVE To compile the instruments validated in Brazil for assessing adherence of people living with HIV to antiretroviral therapy. METHODS Scoping review using the Web of Science, Scopus, Medline (via PubMed), Embase, BDENF, CINAHL and Lilacs databases. In addition, the Preprints bioRxiv, Google Scholar and OpenGrey servers were checked. There was no language restriction for the search, and it considered articles published from the year 1996 onwards. RESULTS Three publications were included in the qualitative synthesis. Following were the instruments identified “Questionário para Avaliação da Adesão ao Tratamento Antirretroviral” (Questionnaire for Assessment of Adherence to Antiretroviral Treatment) developed in Porto Alegre (RS) and published in 2007; the “Escala de autoeficácia para adesão ao tratamento antirretroviral em crianças e adolescentes com HIV/Aids” (Self-efficacy Scale for Adherence to Antiretroviral Treatment in Children and Adolescents with HIV/Aids) developed in São Paulo (SP) and published in 2008; and the “WebAd-Q, um instrumento de autorrelato para monitorar a adesão à terapia antirretroviral em serviços de HIV/Aids no Brasil” (WebAd-Q, a self-report instrument to monitor adherence to antiretroviral therapy in HIV/Aids services in Brazil) developed in São Bernardo do Campo (SP) and published in 2018. The instruments were validated in Brazil, and presented statistically acceptable values for psychometric qualities. CONCLUSION The instruments to assess adherence of people living with HIV to antiretroviral therapy are validated strategies for the Brazilian context. However, their (re)use in different settings and contexts of the nation should be expanded. The use of these instruments by health professionals can improve the understanding of factors that act negatively and positively on antiretroviral therapy adherence, and the proposition of strategies intended to consolidate good adherence and intervene in the treatment of people with low therapeutic engagement.
  • The association between vitamin D and BDNF on cognition in older adults in Southern Brazil Original Articles

    Quialheiro, Anna; d´Orsi, Eleonora; Moreira, Júlia Dubois; Xavier, André Junqueira; Peres, Marco Aurélio

    Abstract in English:

    ABSTRACT OBJECTIVE To estimate the association between vitamin D and the cognitive decline of older adults and evaluate whether this association is mediated by brain-derived neurotrophic factor (BDNF) serum concentration. METHODS Cross-sectional study nested in a population-based cohort. Of the 604 participants in the complementary examination of the EpiFloripa Study, 576 older adults (60 years or older) were eligible for the study. The outcome is cognitive decline evaluated by the Mini-Mental State Examination, the exposure is vitamin D, and BDNF is the mediator. The control variables are age, sex, per capita family income, and educational level. The direct effect of vitamin D and BDNF on cognitive decline and the indirect effect mediated by BDNF was evaluated using path analysis, with the estimation of standardized coefficients. RESULTS Among the participants, we observed a direct and positive effect of vitamin D on cognitive function (Coef: 0.06; 95%CI: 0.02 to 0.11; p < 0.001) and serum BDNF concentration (Coef: 21.55; 95%CI: 9.92 to 33.17; p = 0.002), i.e., the higher the vitamin D, the higher the cognitive function and serum level of BDNF. CONCLUSION There was an association between vitamin D on serum BDNF and on cognitive decline in older adults. Moreover, BDNF did not have an effect on cognitive decline, so BDNF was not a mediator of the vitamin D effect on cognitive decline.
  • Self-assessed masticatory function and frailty in Brazilian older adults: the FIBRA Study Original Articles

    Milagres, Clarice Santana; Tôrres, Luísa Helena do Nascimento; Almeida, Talita Bonato de; Neri, Anita Liberalesso; Antunes, José Leopoldo Ferreira; Sousa, Maria da Luz Rosário de

    Abstract in English:

    ABSTRACT OBJETIVE To investigate the relationship between the masticatory function and the frailty of older people. METHODS Exploratory cross-sectional study using secondary data from the FIBRA Project on the frailty conditions of older people living in urban areas of six Brazilian municipalities, from 2008 to 2009. The population consisted of older adults aged 65 and over with no cognitive impairment. A single session identification questionnaire and the Mini-Mental State Examination (MMSE) were applied, followed by collecting sociodemographic data and data on the participants’ self-assessment of masticatory function, general health, and oral health. RESULTS 2,341 older people (164 frail older adults), of whom 63.2% reported not having seen a dentist in the last year, and approximately 26% of them had three or more functional feeding problems. Older participants (OR = 2.88; 95%CI: 2.01–4.13), who are retired (OR = 2.31; 95%CI: 1.18–5.53), those who were depressed (OR = 2.31; 95%CI: 1.58–3.38), and those who self-assessed their general health as worse compared to others of the same age (OR = 3.91; 95%CI: 2.39–6.40) were at higher risk of frailty. Three or more problems related to the functional aspects of mastication were associated with a greater chance of frailty (OR = 2.06; 95%CI: 1.25–3.41). CONCLUSION This study found an association between masticatory function and a greater chance of frailty among the studied population.
  • Effect of ribociclib on productivity losses due to breast cancer in young women in Brazil Original Articles

    Buehler, Anna Maria; Dionne, Pierre-Alexandre; Chandiwana, David; Pathak, Purnima; Igho-Osagie, Ebuwa

    Abstract in English:

    ABSTRACT OBJETIVE To evaluate the effect of ribociclib versus endocrine therapy on productivity losses due to advanced breast cancer. METHODS Productivity data from the MONALEESA-7 trial, obtained from the results of the application of the Work Productivity and Activity Impairment (WPAI) questionnaire on progression-free survival state (43-month follow-up), were extrapolated to the 10,936 Brazilian prevalent cases of premenopausal women with hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) breast cancer. Productivity loss was determined by quantifying the economic costs of workforce dropout over time in both treatment arms and by discounting the economic costs of absenteeism and presenteeism from workforce retention. A human capital approach was used. RESULTS Net productivity gains in the ribociclib arm were estimated at USD 4,285,525.00, representing 316,609 added work hours over 43 months and a mean of 2,009 added work weeks per year. CONCLUSIONS The phase III MONALEESA-7 trial productivity results applied to the Brazilian premenopausal prevalent cases of hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) breast cancer showed that treatment with ribociclib + endocrine therapy improves workforce participation compared with endocrine therapy alone in premenopausal women with hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) metastatic breast cancer, with potential economic gains for the Brazilian society.
  • Social desirability bias in qualitative health research Original Articles

    Bispo Júnior, José Patrício

    Abstract in Portuguese:

    RESUMO Ensaio com o objetivo de discutir o viés de desejabilidade social na pesquisa qualitativa em saúde. O viés de desejabilidade social consiste em um erro sistemático de pesquisa, no qual o participante apresenta respostas que são mais socialmente aceitáveis do que suas opiniões ou comportamentos verdadeiros. Estudos qualitativos são muito suscetíveis a esse tipo de viés, que pode levar a conclusões distorcidas sobre o fenômeno em estudo. Inicialmente, apresento os aspectos teórico-conceituais do viés de desejabilidade social. Discuto como sua ocorrência pode ser intencional ou não intencional, com diferenciação entre os conceitos de autoengano e gerenciamento de impressão. Em seguida, discuto os fatores determinantes desse viés a partir de quatro dimensões: desenho do estudo; contexto do estudo; característica do entrevistado; postura do entrevistador. Por fim, apresento uma sistematização de seis estratégias a serem utilizadas por pesquisadores qualitativos para a identificação e controle do viés de desejabilidade social.

    Abstract in English:

    ABSTRACT The objective of this essay is to discuss the social desirability bias in qualitative health research. The social desirability bias consists of a systematic research error, in which the participant presents answers that are more socially acceptable than their true opinions or behaviors. Qualitative studies are very susceptible to this type of bias, which can lead to distorted conclusions about the studied phenomenon. Initially, I present the theoretical-conceptual aspects of the social desirability bias. I discuss how its occurrence can be intentional or unintentional, with a distinction between the concepts of self-deception and impression management. Then, I discuss the determining factors of this bias from four dimensions: study design; study context; interviewee's characteristic; interviewer's posture. Finally, I present a systematization of six strategies to be used by qualitative researchers for identifying and controlling social desirability bias.
  • Sexual and gender minority health in Chile: findings from the 2016–2017 Health Survey Original Articles

    Lagunas, Lilian Ferrer; Caceres, Billy; Silva, Margarita Bernales; Passi-Solar, Alvaro; Delgado, Jaime Barrientos; López-Salvo, Francisca; Shah, Ruby; Hughes, Tonda L.

    Abstract in English:

    ABSTRACT OBJECTIVE To expose visibility of the health concerns of sexual and gender minority groups in Chile, as well as to provide a platform to advocate for policies that support the health and well-being of sexual and gender minority people in the country. METHODS The health conditions and risk factors of participants identified as sexual and gender minority were compared to those identified as cisgender heterosexual using data from the 2016-2017 National Health Survey. RESULTS Despite reporting higher self-rated health than heterosexual men, gay men had a higher risk of lifetime diagnosis of sexually transmitted infections. Compared to heterosexual women, the prevalence of depression was higher among bisexual women, who were also less likely to have been tested for HIV. Moreover, transgender participants were more likely to report depression and worse self-rated health than cisgender heterosexual participants. CONCLUSION Small sample sizes of sexual and gender minority subgroups might have obscured some differences that would have been observable in larger samples. Despite this, we found statistically significant sexual and/or gender identity differences in several health areas, especially mental, sexual, and overall health.
  • Food consumption in Brazil: influence of beef on environmental impact and nutritional quality of the diet Original Articles

    Garzillo, Josefa Maria Fellegger; Poli, Vanessa Fadanelli Schoenardie; Leite, Fernanda Helena Marrocos; Martinez-Steele, Euridice; Machado, Priscila Pereira; Louzada, Maria Laura da Costa; Levy, Renata Bertazzi; Monteiro, Carlos Augusto

    Abstract in Portuguese:

    RESUMO OBJETIVO Estimar o consumo de carne bovina e a sua influência nas pegadas de carbono e na pegada hídrica, bem como mesurar a qualidade nutricional da dieta no Brasil. MÉTODOS A quantidade consumida de carne bovina e dos demais alimentos foi avaliada por dois registros alimentares de 24 horas em amostra representativa da população brasileira ≥ 10 anos de idade (n = 32.853) entre 2008 e 2009. O impacto ambiental da dieta considerou os coeficientes da pegada de carbono (gCO2e/kg) e da pegada hídrica (litros/kg) dos alimentos, bem como sua qualidade nutricional considerando a composição de cada alimento em nutrientes associados à prevenção de deficiências nutricionais ou ao aumento/diminuição do risco de doenças crônicas. Modelos de regressão linear e logística, brutos e ajustados para sexo, idade, escolaridade, renda, região e área, foram utilizados para estudar, respectivamente, a associação de quintos da contribuição calórica de carne bovina com os impactos ambientais da dieta e com a ingestão inadequada de nutrientes. RESULTADOS As pegadas de carbono e hídrica e os teores de proteína, ferro, zinco, vitamina B12, gordura saturada e sódio foram maiores na fração da dieta composta por carnes bovinas, enquanto o teor de fibra e de açúcar de adição foram maiores na fração composta pelos demais alimentos. A contribuição dietética de carne bovina mostrou-se associada diretamente com as pegadas de carbono e hídrica da dieta e com o risco de ingestão excessiva de gordura saturada e de sódio, além de ingestão insuficiente de fibra, associando-se inversamente com o risco de ingestão insuficiente de proteína, ferro, zinco e vitamina B12. CONCLUSÃO A redução no consumo de carne bovina no Brasil diminuiria as pegadas de carbono e hídrica da dieta, assim como o risco de doenças crônicas relacionadas à alimentação. Portanto, para não aumentar o risco de deficiências nutricionais, é sugerido o acompanhamento do aumento da ingestão de outros alimentos fontes de proteína, ferro, zinco e vitamina B12.

    Abstract in English:

    ABSTRACT OBJECTIVE To estimate beef consumption and its influence on carbon and water footprints, as well as to improve the nutritional quality of the Brazilian diet. METHODS The amount of beef and other foods consumed was evaluated by two 24-hour food records in a representative sample of the Brazilian population ≥ 10 years of age (n = 32,853) from 2008 to 2009. The environmental impact of the diet considered the coefficients of the carbon footprint (gCO2 and/kg) and the water footprint (liters/kg) of the foods, as well as their nutritional quality considering the nutrient composition of each food associated with the prevention of nutritional deficiencies or the increase/decrease in chronic disease risk. Linear and logistic regression models, crude and adjusted for sex, age, education, income, region, and area, were used to respectively study the association of fifths of the caloric contribution of beef with the environmental impacts of the diet and inadequate nutrient intake. RESULTS Carbon and water footprints and protein, iron, zinc, vitamin B12, saturated fat, and sodium contents were higher in the fraction of the diet composed of beef, whereas fiber and added sugar contents were higher in the fraction composed by the other foods. Dietary beef contribution was directly associated with the carbon and water footprints of the diet and the risk of saturated fat and sodium excess, besides fiber insufficiency, inversely associated with the risk of protein, iron, zinc, and vitamin B12 insufficiency. CONCLUSION Reducing beef consumption in Brazil would also reduce the carbon and water footprints of the diet, as well as the risk of chronic diseases related to food. Therefore, in order not to increase the risk of nutritional deficiencies, monitoring the increased intake of other foods rich in protein, iron, zinc, and vitamin B12 is suggested.
  • Translation and cross-cultural adaptation of the Composite Abuse Scale into Brazilian Portuguese Original Articles

    Rocha, Raiza Wallace Guimaraes da; Oliveira, Daniel Canavese de; Liebel, Vitor Adriano; Pallu, Patricia Helena Rubens; Hegarty, Kelsey Lee; Signorelli, Marcos Claudio

    Abstract in Portuguese:

    RESUMO OBJETIVO Realizar a tradução e adaptação transcultural do inglês para o português brasileiro da Composite Abuse Scale, instrumento que identifica e quantifica a violência por parceiro íntimo. MÉTODOS Este estudo baseia-se na execução rigorosa de seu protocolo, previamente publicado, e que consiste em dez etapas: (a) análise conceitual; (b) tradução duplo-cega; (c) comparação e primeira versão reconciliada das duas traduções; (d) retrotradução; (e) revisão da retrotradução feita pela desenvolvedora e segunda versão reconciliada; (f) revisão por comitê de especialistas (n = 6); (g) comparação das revisões por especialistas e terceira versão reconciliada; (h) entrevistas cognitivas com mulheres da Casa da Mulher Brasileira de Curitiba (n = 15); (i) avaliações das percepções das usuárias e reconciliação final; e (j) apresentação da versão final do questionário à desenvolvedora. RESULTADOS A execução das 10 etapas do protocolo permitiu as equivalências idiomática, semântica, conceitual e experiencial da Composite Abuse Scale, incorporando sugestões e críticas dos diferentes participantes do processo, que incluíram desde a desenvolvedora, tradutores profissionais, pesquisadores especializados no tema, mulheres em situação de violência por parceiro íntimo e profissionais que as atendem. Especialistas e entrevistas cognitivas com mulheres foram fundamentais para garantir equivalências e facilitar a compreensão, incluindo: (1) adaptação do termo “relacionamento íntimo” para “relacionamento afetivo ou conjugal”; (2) substituição de ênclises por próclises em 20 itens; (3) adoção de linguagem de gênero neutro, permitindo sua utilização em relacionamentos hetero, bi e homoafetivos; (4) materialização de um instrumento de rigor científico e autoaplicável, que pode auxiliar as mulheres a visibilizarem as situações de abuso em seus relacionamentos. CONCLUSÕES O processo de tradução e adaptação transcultural da Composite Abuse Scale resultou na Composite Abuse Scale Versão Português brasileiro, instrumento autoaplicável com 30 itens, capaz de identificar e quantificar a violência por parceiro íntimo, sua frequência, severidade e tipologias (violências física, emocional, assédio e grave combinada).

    Abstract in English:

    ABSTRACT OBJECTIVE To perform the translation and cross-cultural adaptation from English into Brazilian Portuguese of the Composite Abuse Scale, an instrument that identifies and quantifies intimate partner violence. METHODS This study is based on the strict implementation of its previously published protocol, which consists of ten steps: (a) conceptual analysis; (b) double-blind translation; (c) comparison and first reconciled version of the two translations; (d) back-translation; (e) review of the back-translation by the developer and second reconciled version; (f) expert committee review (n = 6); (g) comparison of expert reviews and third reconciled version; (h) cognitive interviews with women from the Casa da Mulher Brasileira in Curitiba (n = 15); (i) assessments of user perceptions and final reconciliation; and (j) submission of the final version of the questionnaire to the developer. RESULTS The implementation of the 10 steps of the protocol allowed the idiomatic, semantic, conceptual and experiential equivalences of the Composite Abuse Scale, incorporating suggestions and criticisms from the different participants of the process. Participants included the developer, professional translators, researchers specialized on the subject, women in situation of intimate partner violence, and professionals who provide care to them. Experts and cognitive interviews with women were instrumental in ensuring equivalence, and facilitating the understanding, including: (1) adaptation of the term “intimate relation” to “affective or conjugal relation”; (2) substitution of enclisis for proclisis cases in 20 items; (3) adoption of gender-neutral language, allowing its use in heterosexual, bisexual, and same-sex relations; (4) materialization of an instrument of scientific rigor and self-applicable, which may help women to visualize the situations of abuse in their relations. CONCLUSIONS The translation and cross-cultural adaptation process of the Composite Abuse Scale resulted in the Composite Abuse Scale Brazilian Portuguese Version, a 30-item self-applicable instrument, capable to identify and quantify intimate partner violence, its frequency, severity and typologies (physical, emotional, harassment and severe combined violence).
  • Birth weight is related with bone mineral content in adulthood: results of ELSA-Brasil Original Articles

    Tavares, Nayranne Hivina Carvalho; Coelho, Carolina Gomes; Barreto, Sandhi M.; Giatti, Luana; Araújo, Larissa Fortunato

    Abstract in English:

    ABSTRACT OBJECTIVE To investigate the association between birth weight and bone mineral content (BMC), and whether this relationship differs between men and women. METHODS A total of 10,159 participants from the ELSA-Brasil cohort were eligible for this analysis. The outcome was the z-score of the ratio BMC (kg)/height (m). The exposure was the low birth weight (< 2.5kg). The magnitude of the associations was estimated by mean differences and their respective 95% confidence intervals (95%CI) using linear regression. All analyses were presented for the total population and stratified by sex. RESULTS Most were women (54.98%), and the mean age was 52.72 years (SD ± 6.6). In the crude model, we observed that low birth weight was associated with a lower mean BMC/height z-score, compared to adequate birth weight (mean difference: −0.30; 95%CI: −0.39 to −0.21), and this effect was stronger in men (mean difference: −0.43; 95%CI: −0.56 to −0.30) than in women (mean difference: −0.31; 95%CI: −0.44 to −0.19). After adjusting for age, sex per total population, race/skin color, maternal education, individual education, and current weight, there was a considerable reduction in the magnitude of the association (total population: −0.10; 95%CI: −0.14 to −0.06; men: −0.13; 95%CI: −0.21 to −0.06; women: −0.13; 95%CI: −0.21 to −0.05). CONCLUSION Low birth weight is related to BMC/height z-score in both sexes with no indication of differences by sex. The magnitude of the associations was attenuated after adjustment for the current weight.
  • Prevalence of anemia among Indigenous children in Latin America: a systematic review Review

    Rosas-Jiménez, Carlos; Tercan, Engin; Horstick, Olaf; Igboegwu, Ekeoma; Dambach, Peter; Louis, Valérie R.; Winkler, Volker; Deckert, Andreas

    Abstract in English:

    ABSTRACT OBJECTIVE: To describe the prevalence pattern of anemia among Indigenous children in Latin America. METHODS: PRISMA guidelines were followed. Records were identified from the databases PubMed, Google Scholar, and Lilacs by two independent researchers between May and June 2021. Studies were included if the following criteria were met: a) studied Indigenous people b) was about children (from 0 to 12 years old); c) reported a prevalence estimate of anemia; d) had been conducted in any of the countries of Latin America; e) was published either in English, Portuguese, or Spanish; f) is a peer-reviewed article; and g) was published at any date. RESULTS: Out of 2,401 unique records retrieved, 42 articles met the inclusion criteria. A total of 39 different Indigenous communities were analyzed in the articles, and in 21 of them (54.0%) child anemia was a severe public health problem (prevalence ≥ 40%). Those communities were the Aymara (Bolivia); Aruak, Guaraní, Kamaiurá, Karapotó, Karibe, Kaxinanuá, Ma-cro-Jê, Suruí, Terena, Xavante (Brazil); Cabécar (Costa Rica), Achuar, Aguaruna, Awajún, Urarina, Yomybato (Peru); Piaroa and Yucpa (Venezuela); and Quechua (Peru and Bolivia). Children below two years had the highest prevalence of anemia (between 16.2% and 86.1%). Among Indigenous people, risk factors for anemia include nutrition, poor living conditions, access to health services, racism, and discrimination. Bolivia and Guatemala are scarcely studied, despite having the highest proportion of Indigenous communities in Latin America. CONCLUSIONS: Anemia constitutes a poorly documented public health problem among Indigenous children in 21 Indigenous communities in Bolivia, Brazil, Colombia, Costa Rica, Ecuador, Guatemala, Mexico, and Peru. In all Indigenous communities included in this study child anemia was an issue, especially in younger children.
  • Covid-19: temporal evolution and immunization in the three epidemiological waves, Brazil, 2020–2022 Original Articles

    Moura, Erly Catarina; Cortez-Escalante, Juan; Cavalcante, Fabrício Vieira; Barreto, Ivana Cristina de Holanda Cunha; Sanchez, Mauro Niskier; Santos, Leonor Maria Pacheco

    Abstract in Portuguese:

    RESUMO OBJETIVO Descrever a evolução temporal da morbimortalidade por covid-19 e da cobertura vacinal no período da emergência sanitária no Brasil. MÉTODOS Número de casos e óbitos por covid-19 foram extraídos do painel público do Ministério da Saúde, conforme semana epidemiológica (SE) e região geográfica. Dados sobre vacinas e variantes foram obtidos, respectivamente, do Sistema de Informação do Programa Nacional de Imunizações e do Sistema de Vigilância Genômica do SARS-CoV-2. RESULTADOS A evolução da pandemia de covid-19 caracterizou-se por três picos de óbitos: na 30ᵃ semana epidemiológica de 2020, na 14ᵃ de 2021 e na sexta de 2022; três ondas de casos, iniciando-se nas regiões Norte e Nordeste, com maiores taxas na terceira onda, principalmente na região Sul. A vacinação teve início na terceira semana epidemiológica de 2021, atingindo rapidamente a maior parte da população, particularmente nas regiões Sudeste e Sul, coincidindo com redução da taxa de mortalidade, mas não de morbidade na terceira onda. No total, 146.718 genomas foram sequenciados, mas somente a partir do início da segunda onda, na qual a variante dominante foi a Gama. A partir da última SE de 2021, quando a cobertura vacinal já se aproximava de 70%, a variante Ômicron causou uma avalanche de casos, porém com menos óbitos. CONCLUSÕES É nítida a presença de três ondas de covid-19, bem como o efeito da imunização na redução da mortalidade na segunda e na terceira ondas, atribuídas às variantes Delta e Ômicron, respectivamente. Contudo não houve efeito na redução da morbidade, que atingiu o pico na terceira onda, na qual dominou a variante Ômicron. O comando nacional e centralizado do enfrentamento à pandemia não ocorreu; assim, os gestores locais assumiram a liderança em seus territórios. O efeito avassalador da pandemia poderia ter sido minimizado, caso houvesse a participação coordenada das três esferas de governo no SUS.

    Abstract in English:

    ABSTRACT OBJECTIVE Describe the temporal evolution of morbimortality due to Covid-19 and vaccination coverage during the health emergency in Brazil. METHODS Number of cases and deaths due to Covid-19 were extracted from the public panel of the Brazilian Ministry of Health, according to epidemiological week (EW) and geographic region. Data on vaccines and variants were obtained, respectively, from the Information System of the National Immunization Program and the Genomic Surveillance System of SARS-CoV-2. RESULTS Three peaks of deaths characterized the evolution of the Covid-19 pandemic: in EW 30 of 2020, in the EW 14 of 2021 and in the EW six of 2022; three case waves, starting in the North and Northeast regions, with higher rates in the third wave, mainly in the South region. Vaccination started in the epidemiological week three of 2021, rapidly reaching most of the population, particularly in the Southeast and South regions, coinciding with a reduction exclusively in the mortality rate in the third wave. Only from the beginning of the second wave, when Gama was the dominant variant, 146,718 genomes were sequenced. From the last EW of 2021, with vaccination coverage already approaching 70%, the Omicron variant caused an avalanche of cases, but with fewer deaths. CONCLUSIONS We noticed the presence of three waves of Covid-19, as well as the effect of immunization on the reduction of mortality in the second and third waves, attributed to the Delta and Omicron variants, respectively. However, the reduction of morbidity, which peaked in the third wave during the domination of the Omicron variant, remained the same. The national and centralized command of the pandemic confrontation did not occur; thus, public administrators took the lead in their territories. The overwhelming effect of the pandemic could have been minimized, if there had been a coordinated participation of three spheres of the Brazilian Unified Health System administration, in the joint governance of the pandemic fight.
  • Scientometric analysis of research on trachoma in Brazil, 2000–2020 Original Articles

    Maciel, Adjoane Maurício Silva; Ramos Júnior, Alberto Novaes; Ferreira, Anderson Fuentes; Almeida, Nádia Maria Girão Saraiva de; Gomes, Vivian da Silva; Gómez, Daniela Vaz Ferreira; Pires Neto, Roberto da Justa

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar o perfil cienciométrico das pesquisas sobre tracoma no Brasil. MÉTODOS Pesquisa bibliográfica de publicações sobre tracoma no Brasil indexadas pela base de dados da Scopus, a partir de critérios específicos no período de 2000 a 2020. Foram extraídos e analisados dados sobre autoria, país de origem, instituições e descritores, com análises de tendências temporais. As redes bibliográficas foram construídas via software de visualização cienciométrica VOSviewer® 1.6.16. RESULTADOS Do total de 42 publicações analisadas sobre tracoma no Brasil, observou-se média anual de dois artigos, com incremento de aproximadamente 50% no período. Verificou-se média de três autores por documento e os inquéritos escolares foram a categoria de assunto mais comum. Os artigos publicados provêm majoritariamente de instituições brasileiras (95,2%), principalmente das sediadas nas regiões Sudeste e Norte. Dez autores mais produtivos estão mencionados nas primeiras autorias em 26,2% (11/42) das publicações e as instituições predominantes estão afiliadas ao estado de São Paulo. O termo Trachoma (n = 18) apresenta maior recorrência como descritor. CONCLUSÃO Esta primeira análise cienciométrica sobre tracoma no Brasil evidencia limitado número de pesquisas sobre essa doença. Há discreto incremento da produção científica, apesar da concentração da origem em áreas geográficas com menor endemicidade da doença. Maiores investimentos são necessários para o melhor entendimento e controle dessa doença tropical negligenciada. A análise da produção bibliográfica tem papel relevante para fortalecimento do desenvolvimento de pesquisas e planejamento estratégico de programas para o controle de tracoma e doenças tropicais negligenciadas em geral.

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze the scientometric profile of research on trachoma in Brazil. METHODS Bibliographic research of publications on trachoma in Brazil indexed by the Scopus database from 2000 to 2020, based on specific criteria. Data on authorship, country of origin, institutions, and keywords were collected and analyzed with analysis of time trends. Bibliographic networks were constructed via a scientometric visualization software—VOSviewer® 1.6.16. RESULTS We analyzed 42 publications on trachoma in Brazil. The annual average was two articles, with an increase of about 50% during the period. The average number of authors was three per document and school surveys were the most common subject category. Most published articles came from Brazilian institutions (95.2%), mainly those based in Southeast and North Brazil. Of the most productive authors, 10 were mentioned as first author in 26.2% of publications (11/42) and the predominant institutions are based in the state of São Paulo. The term “trachoma” (n = 18) was the most recurrent keyword. CONCLUSION This first scientometric analysis of research on trachoma in Brazil showed a limited number of studies on this disease. The scientific production slightly increased, although the origin of many studies is geographical areas with lower endemicity of this disease. Greater investments are needed for a better understanding and control of this neglected tropical disease. The analysis of bibliographic production on this topic is important to strengthen the development of research and strategic planning of programs for the control of trachoma and neglected tropical diseases in general.
  • Double burden of malnutrition as a risk factor for overweight and obesity Original Articles

    Bernabé-Ortiz, Antonio; Quinteros-Reyes, Carmen; Carrillo-Larco, Rodrigo M.

    Abstract in English:

    ABSTRACT OBJECTIVE To assess the longitudinal effect of double burden of malnutrition (DBM) on the risk of developing child and adolescent overweight or obesity. METHODS Analysis of the Peruvian Young Lives Study, younger cohort: baseline (2002) and 4 follow-ups (2006–2007, 2009–2010, 2013–2014, and 2016–2017). Outcomes were the incidence of overweight and obesity as defined by the World Health Organization standards. The exposure comprised a variable with 4 categories: non-stunted child with a non-overweight mother (reference group), non-stunted child with an overweight mother, stunted child with a non-overweight mother, and stunted child with an overweight mother (i.e., DBM). Poisson regression models were built to assess the association of interest, and relative risks (RR) and 95%CI were reported. RESULTS Data from 2,034 children; 50.0% were girls and the mean age was 12.0 (3.6) months at baseline. Non-stunted children with an overweight mother had greater risk (RR = 1.64; 95%CI: 1.35–1.99) of developing overweight, compared with the risk for stunted children with a non-overweight mother (RR = 1.38; 95%CI: 1.10–1.72), and for those with DBM (RR = 1.28; 95%CI: 1.02–1.61). When compared with the reference group, obesity risk was greater among non-stunted children with an overweight mother (RR = 2.33; 95%CI: 1.68–3.22), greater among stunted children with a non-overweight mother (RR = 2.59; 95%CI: 1.75–3.84), and greater among those with DBM (RR = 2.14; 95%CI: 1.39–3.28). CONCLUSIONS DBM is a risk factor for childhood overweight and obesity in Peru. Dual-duty policies tackling both undernutrition in children and overweight in mothers are needed to reduce DBM and its future effects in Peru.
  • Errata: Sampling plan and methodological aspects: a household healthcare survey in Piauí

  • Primary health care organization in the Covid-19 pandemic: scoping review Review

    Silva, Breno Ribeiro Gonçalves da; Corrêa, Ana Paula de Vechi; Uehara, Sílvia Carla da Silva André

    Abstract in Portuguese:

    RESUMO OBJETIVO Mapear evidências científicas disponíveis sobre a organização dos serviços e profissionais da atenção primária à saúde durante o enfrentamento da covid-19. MÉTODO Trata-se de uma revisão de escopo, seguindo o método do Joanna Briggs Institute. Foram incluídos estudos publicados em português, espanhol e inglês, no período de janeiro/2020 a janeiro/2021, nas bases de dados CINAHL, Lilacs, Medline, PubMed e Web of Science. RESULTADOS Foram selecionados 24 artigos, que mostraram a reorganização dos serviços e profissionais da atenção primária à saúde para o atendimento de casos suspeitos ou confirmados de covid-19. As ações de coordenação do enfrentamento da doença na atenção primária à saúde colaboram no controle da infecção, especialmente por meio de busca ativa de sintomáticos respiratórios e detecção de casos novos, seguido do monitoramento dos casos confirmados. CONCLUSÕES O presente estudo mostra um panorama de como profissionais e serviços da atenção primária se organizaram no enfrentamento da pandemia, abordando as readequações adotadas na infraestrutura e fluxos de atendimentos, a exemplo da adoção de unidades específicas no atendimento para covid-19, separação de fluxos infectado/não infectado, telemedicina como alternativa de modalidade de atendimento e monitoramento dos casos por meio de aplicativos e telefone.

    Abstract in English:

    ABSTRACT OBJECTIVE Mapping available scientific evidence on the organization of primary health care services and professionals during the Covid-19 pandemic. METHODS This is a scoping review that followed the Joanna Briggs Institute method. Articles published in Portuguese, Spanish, and English from January 2020 to January 2021 in the CINAHL, Lilacs, Medline, PubMed, and Web of Science databases were included. RESULTS We selected 24 articles that presented the reorganization of primary health care services and professionals to care suspected or confirmed Covid-19 cases. Coordination measures to tackle this disease in primary health care help to control its infection, especially by the active search for respiratory symptoms, the detection of new cases, and the monitoring of confirmed cases. CONCLUSION This study presents an overview of how primary health care services and professionals organized themselves to tackle the Covid-19 pandemic, addressing adjustments in infrastructure and care flows, such as establishing specific Covid-19 care units, separating infected and non-infected patients, using telemedicine as an alternative modality of care, and monitoring cases by applications and phone.
  • Differentials in death count records by databases in Brazil in 2010 Original Articles

    Diógenes, Victor Hugo Dias; Pinto Júnior, Elzo Pereira; Gonzaga, Marcos Roberto; Queiroz, Bernardo Lanza; Lima, Everton E. C.; Costa, Lilia Carolina C. da; Rocha, Aline S.; Ferreira, Andrêa J. F.; Teixeira, Camila S. S.; Alves, Flávia Jôse O.; Rameh, Leila; Flores-Ortiz, Renzo; Leyland, Alastair; Dundas, Ruth; Barreto, Maurício L.; Ichihara, Maria Yury Travassos

    Abstract in English:

    ABSTRACT OBJECTIVE To compare the death counts from three sources of information on mortality available in Brazil in 2010, the Mortality Information System (SIM - Sistema de Informações sobre Mortalidade ), Civil Registration Statistic System (RC - Sistema de Estatísticas de Resgistro Civil ), and the 2010 Demographic Census at various geographical levels, and to confirm the association between municipal socioeconomic characteristics and the source which showed the highest death count. METHODS This is a descriptive and comparative study of raw data on deaths in the SIM, RC and 2010 Census databases, the latter held in Brazilian states and municipalities between August 2009 and July 2010. The percentage of municipalities was confirmed by the database showing the highest death count. The association between the source of the highest death count and socioeconomic indicators - the Índice de Privação Brasileiro (IBP – Brazilian Deprivation Index) and Índice de Desenvolvimento Humano Municipal (IHDM – Municipal Human Development Index) - was performed by bivariate choropleth and Moran Local Index of Spatial Association (LISA) cluster maps. RESULTS Confirmed that the SIM is the database with the highest number of deaths counted for all Brazilian macroregions, except the North, in which the highest coverage was from the 2010 Census. Based on the indicators proposed, in general, the Census showed a higher coverage of deaths than the SIM and the RC in the most deprived (highest IBP values) and less developed municipalities (lowest IDHM values) in the country. CONCLUSION The results highlight regional inequalities in how the databases chosen for this study cover death records, and the importance of maintaining the issue of mortality on the basic census questionnaire.
  • Association between socioeconomic level and cardiovascular risk in the Peruvian population Original Articles

    Cerpa-Arana, Stefany Katherine; Rimarachín-Palacios, Lourdes Magaly; Bernabé-Ortiz, Antonio

    Abstract in Spanish:

    RESUMEN OBJETIVO Determinar la asociación entre el nivel socioeconómico y la presencia de obesidad, hipertensión y diabetes mellitus tipo 2 en la población peruana. MÉTODOS Análisis de datos secundarios de la Encuesta Nacional Demográfica y de Salud Familiar (Endes) del 2018 al 2020. Las variables dependientes fueron obesidad, hipertensión y diabetes mellitus tipo 2, y las variables independientes fueron dos indicadores de nivel socioeconómico: el nivel educativo (< 7 años, 7–11 años y 12+ años) y el índice de bienestar (en terciles). Se crearon modelos usando regresión de Poisson, reportando razones de prevalencia (RP) e intervalos de confianza al 95% (IC95%). RESULTADOS Se analizaron los datos de 98.846 sujetos, edad promedio: 45,3 (DE: 16,0) años, y 55,5% fueron mujeres. La prevalencia de obesidad fue del 26% (IC95% 25,4–26,6); la de hipertensión, 24,9% (IC95% 24,3–25,5); y la de diabetes mellitus tipo 2, 4,8% (IC95% 4,5–5,1). En modelo multivariable y comparado con los de índice de bienestar bajo, aquellos con índice de bienestar alto tenían mayor prevalencia de obesidad (RP = 1,49; IC95% 1,38–1,62), de hipertensión (RP = 1,09; IC95% 1,02–1,17) y de diabetes mellitus tipo 2 (RP = 1,72; IC95% 1,29–2,29). De otro lado, mayor nivel educativo sólo se asoció a una reducción en la prevalencia de obesidad (RP = 0,89; IC95% 0,84–0,95). CONCLUSIONES Existe asociación diferencial entre el índice de bienestar, nivel educativo y marcadores de enfermedades no transmisibles: hay evidencia de asociación positiva entre el índice de bienestar y obesidad, hipertensión y diabetes mellitus tipo 2, mientras que el nivel educativo solo estuvo asociado de forma negativa a obesidad.

    Abstract in English:

    ABSTRACT OBJECTIVE To determine the association between socioeconomic level and the presence of obesity, hypertension and type 2 diabetes mellitus in the Peruvian population. METHODS Secondary analysis of data from the National Demographic and Family Health Survey ( Encuesta Nacional Demográfica y de Salud Familiar , Endes) from 2018 to 2020. The outcomes were obesity, hypertension, and type 2 diabetes mellitus. The exposure variables were two indicators of socioeconomic status: educational level (< 7 years, 7–11 years, and 12+ years) and wealth index (in tertiles). Models were created using Poisson regression, reporting prevalence ratios (PR) and 95% confidence intervals (95%CI). RESULTS Data from 98,846 subjects were analyzed. Mean age: 45.3 (SD: 16.0) years, and 55.5% were women. The prevalence of obesity was 26.0% (95%CI: 25.4–26.6); of hypertension, 24.9% (95%CI: 24.3–25.5); and of type 2 diabetes mellitus, 4.8% (95%CI: 4.5–5.1). In multivariate model, and compared with those with a low wealth index, those with a high wealth index had a higher prevalence of obesity (PR = 1.49; 95%CI: 1.38–1.62), hypertension (PR = 1.09; 95%CI: 1.02–1.17) and type 2 diabetes mellitus (PR = 1.72; 95%CI: 1.29–2.29). On the other hand, higher educational level was only associated with a reduction in the prevalence of obesity (PR = 0.89; 95%CI: 0.84–0.95). CONCLUSIONS There is a differential association between the wealth index, educational level and markers of noncommunicable diseases. There is evidence of a positive association between wealth index and obesity, hypertension and type 2 diabetes mellitus, whereas educational level was only negatively associated with obesity.
  • An update on the status of breast cancer screening in Brazil after the covid-19 pandemic Brief Communication

    Bessa, Jordana de Faria; Novita, Guilherme; Freitas-Junior, Ruffo

    Abstract in English:

    ABSTRACT We have previously reported the impact of covid-19 pandemic on breast cancer screening, in Brazil: among women aged 50–69 years, mammography attendance decreased by 42% in public healthcare (SUS), comparing 2019 and 2020. In this short communication, we wish to present: a) an update of the number of mammograms performed, in 2021; b) an exploratory analysis of the characteristics of the screened population between 2019 and 2021. A total of 1.675.307 mammograms were performed in 2021, nearly 15% lower than pre-pandemic levels. Almost a third, 29.5% of them, had intervals greater than three years. In accordance with our previous study, the number of patients with palpable lumps on physical exam increased. The consequences of postponing breast cancer screening during the pandemic are still uncertain. Unfortunately, as of December 2021, screening attendance has not resumed. On the contrary, our results show an increase in the fraction of women with mammography delayed beyond three years.
  • Assistance to black people in the Juquery asylum from 1898 to 1930 Original Articles

    Avezani, Amanda Carolina Franciscatto; Marcolan, João Fernando

    Abstract in Portuguese:

    RESUMO OBJETIVO Desvelar a assistência prestada aos indivíduos negros internados no período de 1898 a 1930 no Hospício do Juquery, considerados o contexto social e a hegemonia do saber médico da época. MÉTODOS Estudo exploratório-descritivo, qualitativo, análise documental, em prontuários de indivíduos negros(as) internados(as) desde a abertura do Hospício do Juquery em 1898 até 1930. Recorte temporal abarcou direções institucionais específicas e contexto histórico, político, econômico e social vivenciado pela população negra. Realizado no Arquivo do Patrimônio Histórico-cultural do Complexo Hospitalar do Juquery, entre julho e dezembro de 2019. Utilizado instrumento com questões referentes a dados sociodemográficos, data e anamnese de entrada, exame físico e psíquico, hipótese diagnóstica, tratamentos realizados, intercorrências, desfecho e motivo. Análise realizada segundo etapas da análise documental e pautada nos referenciais teóricos psiquiátricos do período. RESULTADOS Foram vistos todos os prontuários do período, cerca de 6.300, dos quais aproximadamente 1.400 eram de negros(as). Desses prontuários, foram incluídos 457, 140 de mulheres e 317 de homens, considerados com informações significativas para objetivos do estudo. Maioria dos participantes teve internações de longa permanência, cuja finalidade não pareceu estar atrelada à possibilidade de cura ou reinserção social, mas à segregação. A partir dos diagnósticos descritos, a impressão é que esses sujeitos compunham nicho com condições imutáveis, permanentes, não passíveis de terapêuticas que possibilitassem retorno à sociedade, exemplificada pela degeneração. Quantidade significativa dos prontuários não traz dados sobre tratamentos, o que reforça a hipótese de que eram mantidos internados não para proposta de cuidado, mas como um depósito da incurabilidade; quando trazem dados observamos empirismo voluntarioso do médico. Metade dos prontuários descreve os desfechos das pessoas internadas e apontam registros muito altos de mortes, seguidos de encaminhamentos para outras instituições de internação a prolongar a vida de confinamento. CONCLUSÕES Internados sofreram com isolamento e assistência focados na política de Estado aliada à ciência, sobretudo psiquiátrica, para legitimar exclusão dos socialmente indesejáveis.

    Abstract in English:

    ABSTRACT OBJECTIVE To reveal the assistance provided to black individuals hospitalized at the Juquery Asylum from 1898 to 1930, having considered the social context and the hegemony of medical knowledge of the time. METHODS Exploratory-descriptive, qualitative study, documentary analysis, in medical records of black individuals hospitalized at the Juquery Asylum from 1898 to 1930. The time frame encompassed specific institutional directions as well as the historical, political, economic, and social context experienced by the black population. Held at the archive of the historical and cultural heritage of the Juquery Hospital Complex, between July and December 2019. We used an instrument with questions related to sociodemographic data, date and anamnesis of entry, physical and psychological examination, diagnostic hypothesis, treatments performed, complications, outcome, and motive. The analysis was carried out according to stages of documentary analysis and was based on psychiatric theoretical references of the period. RESULT All medical records of the period were read (approximately 6,300), of which about 1,400 were of black individuals. Of these medical records, 457 were included, 140 of women and 317 of men, which were considered to have significant information for the study’s objectives. Most of the participants had long-term hospitalizations, whose motive did not seem to be linked to the possibility of cure or social reintegration, but rather to segregation. From the diagnoses described, the impression is that these subjects composed a niche with immutable, permanent conditions, not amenable to therapeutics that would allow their return to society, exemplified by degeneration. A significant amount of the medical records do not contain data on treatments, which reinforces the hypothesis that they were kept hospitalized not for the purpose of care, but as a deposit of incurability; when they do bring data, we observe willful empiricism of the physician. Half of the medical records describe the outcomes of hospitalized people and indicate very high records of deaths, followed by referrals to other hospitalization institutions to prolong confinement. CONCLUSIONS Internees suffered from isolation and assistance focused on state policy allied to science, especially psychiatry, to legitimize exclusion of the socially undesirable.
  • Impact of children with complex chronic conditions on costs in a tertiary referral hospital Original Articles

    Mattiello, Regina Maria Antunes; Pazin-Filho, Antonio; Aragon, Davi Casale; Cupo, Palmira; Carlotti, Ana Paula de Carvalho Panzeri

    Abstract in English:

    ABSTRACT OBJECTIVES To investigate the impact of complex chronic conditions on the use of healthcare resources and hospitalization costs in a pediatric ward of a public tertiary referral university hospital in Brazil. METHODS This is a longitudinal study with retrospective data collection. Overall, three one-year periods, separated by five-year intervals (2006, 2011, and 2016), were evaluated. Hospital costs were calculated in three systematic samples of 100 patients each, consisting of patients with and without complex chronic conditions in proportion to their participation in the studied year. RESULTS Over the studied period, the hospital received 2,372 admissions from 2,172 patients. The proportion of hospitalized patients with complex chronic conditions increased from 13.3% in 2006 to 16.9% in 2016 as a result of a greater proportion of neurologically impaired children, which rose from 6.6% to 11.6% of the total number of patients in the same period. Patients’ complexity also progressively increased, which greatly impacted the use of healthcare resources and costs, increasing by 11.6% from 2006 (R$1,300,879.20) to 2011 (R$1,452,359.71) and 9.4% from 2011 to 2016 (R$1,589,457.95). CONCLUSIONS Hospitalizations of pediatric patients with complex chronic conditions increased from 2006 to 2016 in a Brazilian tertiary referral university hospital, associated with an important impact on hospital costs. Policies to reduce these costs in Brazil are greatly needed.
  • HIV knowledge and its correlation with the Undetectable = Untransmittable slogan in Brazil Brief Communication

    Ferreira, Rayane C.; Torres, Thiago Silva; Marins, Luana Monteiro Spindola; Ceccato, Maria das Graças B.; Bezerra, Daniel R. B.; Luz, Paula M.

    Abstract in English:

    ABSTRACT Knowledge about HIV transmission and prevention is a necessary step for adopting preventive behaviors. We assessed HIV knowledge and its correlation with the perceived accuracy of the “Undetectable = Untransmittable” (U=U) slogan in an online sample with 401 adult Brazilians. Overall, 28% of participants showed high HIV knowledge level. The perceived accuracy of the U=U slogan significantly correlated with HIV knowledge. Younger participants, those reporting lower income or lower education, or who had never tested for HIV showed poorer HIV knowledge. Filling gaps of knowledge among specific populations is urgent in order to increase preventive behaviors and decrease HIV stigma.
  • Mortality inequalities measured by socioeconomic indicators in Brazil: a scoping review Review

    Ichihara, Maria Yury; Ferreira, Andrêa J.F.; Teixeira, Camila S. S.; Alves, Flávia Jôse O.; Rocha, Aline Santos; Diógenes, Victor Hugo Dias; Ramos, Dandara Oliveira; Pinto Júnior, Elzo Pereira; Flores-Ortiz, Renzo; Rameh, Leila; Costa, Lilia Carolina C. da; Gonzaga, Marcos Roberto; Lima, Everton E. C.; Dundas, Ruth; Leyland, Alastair; Barreto, Maurício L.

    Abstract in English:

    ABSTRACT OBJECTIVE Summarize the literature on the relationship between composite socioeconomic indicators and mortality in different geographical areas of Brazil. METHODS This scoping review included articles published between January 1, 2000, and August 31, 2020, retrieved by means of a bibliographic search carried out in the Medline, Scopus, Web of Science, and Lilacs databases. Studies reporting on the association between composite socioeconomic indicators and all-cause, or specific cause of death in any age group in different geographical areas were selected. The review summarized the measures constructed, their associations with the outcomes, and potential study limitations. RESULTS Of the 77 full texts that met the inclusion criteria, the study reviewed 24. The area level of composite socioeconomic indicators analyzed comprised municipalities (n = 6), districts (n = 5), census tracts (n = 4), state (n = 2), country (n = 2), and other areas (n = 5). Six studies used composite socioeconomic indicators such as the Human Development Index, Gross Domestic Product, and the Gini Index; the remaining 18 papers created their own socioeconomic measures based on sociodemographic and health indicators. Socioeconomic status was inversely associated with higher rates of all-cause mortality, external cause mortality, suicide, homicide, fetal and infant mortality, respiratory and circulatory diseases, stroke, infectious and parasitic diseases, malnutrition, gastroenteritis, and oropharyngeal cancer. Higher mortality rates due to colorectal cancer, leukemia, a general group of neoplasms, traffic accident, and suicide, in turn, were observed in less deprived areas and/or those with more significant socioeconomic development. Underreporting of death and differences in mortality coverage in Brazilian areas were cited as the main limitation. CONCLUSIONS Studies analyzed mortality inequalities in different geographical areas by means of composite socioeconomic indicators, showing that the association directions vary according to the mortality outcome. But studies on all-cause mortality and at the census tract level remain scarce. The results may guide the development of new composite socioeconomic indicators for use in mortality inequality analysis.
  • Hospitalizations and adverse drug events in the Brazilian unified health system: a ten-year retrospective analysis of routine data Original Articles

    Silva, Lunara Teles; Modesto, Ana Carolina Figueiredo; Oliveira, Rodrigo Alves de; Amaral, Rita Goreti; Lopes, Flavio Marques

    Abstract in English:

    ABSTRACT OBJECTIVE To describe the frequency and characteristics of hospitalizations for/with adverse drug events in the Brazilian unified health system routine data. METHODS Nationwide retrospective study using data obtained from a period of ten years from the Brazil Hospital Information System (SIH-SUS), an administrative database that registers hospitalizations in the unified health system. We selected hospitalizations with primary and/or secondary diagnosis related to adverse drug events according to a list of validated International Classification Disease 10th edition (ICD-10) codes. These events were described according to year, age group, sex, length of hospital stay, mortality, hospital costs, Brazilian geographical region, and category of ICD-10 codes. Crude hospitalization rates of adverse drug events per 100,000 inhabitants were obtained and Joinpoint Regression was used to analyze temporal changes in these rates along the years. The most frequent ICD-10 codes were also identified. RESULTS Over ten years, 603,663 hospitalizations in Brazil were found in the database, out of which 2.5% of the patients died. Though 2009 had the highest prevalence of hospitalization per 100,000 inhabitants (32.57), no significant annual change in rates was found for the entire period. All age groups and sexes presented a jointpoint in temporal series; however, only women had a significative increase trend. The most frequent codes were from the chapter of mental and behavioral disorders (F19.2, F19.0, and F19.5 codes). CONCLUSIONS The database methodology can be useful to estimate frequencies of adverse drug events and perform characterization nationwide and to help monitor morbidity along the years.
  • Condom use and non-use among transgender women in Colombia: a qualitative analysis based on the IMB model Original Articles

    Moncayo Quevedo, Jorge Eduardo; Pérez-Arizabaleta, María Del Mar; Reyes Sevillano, Wilmar Hernán

    Abstract in Spanish:

    RESUMEN OBJETIVO Analizar las razones del uso y no uso del condón que tienen las mujeres trans de Colombia desde el modelo de información, motivación y habilidades conductuales (IMB por sus siglas en inglés). MÉTODO Estudio cualitativo en el cual se llevó a cabo el análisis de proceso iterativo. Se realizó un grupo focal de manera presencial y entrevistas a profundidad de manera virtual. RESULTADOS Primer estudio llevado a cabo en Colombia sobre el uso del preservativo en mujeres trans bajo el modelo IMB. En el componente información se identifica que la educación sexual tradicional no tiene un impacto positivo. Respecto a lo motivacional, se destaca la importancia del apoyo y acompañamiento familiar y de las organizaciones de base comunitaria para motivar al cuidado de la salud sexual y el uso del preservativo. Con relación a las habilidades conductuales, se analiza que la desconfianza hacia la pareja sexual y la adquisición de los preservativos promueven su uso. CONCLUSIONES Se hace importante la creación de espacios de educación sexual realizados por y para la población LGBTIQ, acompañados por el saber médico de los centros de salud, para impactar de manera positiva la salud sexual de mujeres trans; se motiva a la realización de estudios con parejas sexuales de mujeres trans para conocer las razones por las cuales solicitan el no uso del preservativo.

    Abstract in English:

    ABSTRACT OBJECTIVE Review the reasons for condom use and non-use among transgender women in Colombia based on the information, motivation and behavioral skills (IMB) model. METHOD Qualitative study in which an iterative process analysis was carried out. A focal group participated in person, and in-depth interviews were conducted virtually. RESULTS First study carried out in Colombia on condom use among transgender women under the IMB model. The information component finds that traditional sexual education does not have a positive impact. Regarding motivational aspects, the importance of family support and follow-up and community-based organizations to motivate sexual health care and condom use is highlighted. Regarding behavioral skills, it was found that distrust towards sexual partners and the acquisition of condoms promote their use. CONCLUSIONS It is important to create spaces for sexual education delivered by and for the LGBTIQ population, followed by the medical knowledge of health centers, to have positive impacts on the sexual health of transgender women; studies with sexual partners of transgender women are encouraged in order to know the reasons why they request the non-use of condoms.
  • Common mental disorders in pregnancy and postnatal depressive symptoms in the MINA-Brazil study: occurrence and associated factors Original Articles

    Silva, Bruno Pereira da; Matijasevich, Alicia; Malta, Maíra Barreto; Neves, Paulo A R; Mazzaia, Maria Cristina; Gabrielloni, Maria Cristina; Castro, Márcia C; Cardoso, Marly Augusto

    Abstract in Portuguese:

    RESUMO OBJETIVO Investigar a ocorrência e os fatores associados com os transtornos mentais comuns na gestação e sintomas depressivos no pós-parto, bem como a associação entre ambos na Amazônia Ocidental Brasileira. MÉTODOS Coorte prospectiva no estudo MINA-Brasil com mulheres atendidas na atenção primária à saúde de Cruzeiro do Sul, Acre. Foram realizadas duas avaliações clínicas na gestação (primeira: 16–20 semanas; segunda: 28 semanas gestacionais) e três avaliações no pós-parto (aos 3, 6 e 12 meses), nas quais foram coletados dados demográficos e socioeconômicos, gestacionais, de estilo de vida e clínicos. Utilizou-se o Self-Reported Questionnaire (escore ≥ 8) para rastreamento do transtorno mental comum gestacional e a escala de depressão pós-natal de Edimburgo (escore ≥ 10) para identificação de sintomas depressivos pós-parto. Foi utilizada regressão logística ordinal ajustada para investigar a relação entre as covariáveis e a ocorrência de transtornos mentais comuns na gravidez e a sintomatologia depressiva no pós-parto. RESULTADOS Um total de 461 mulheres completaram as duas avaliações clínicas na gestação; dessas, 247 completaram as três avaliações pós-parto. A ocorrência de transtorno mental comum durante a gestação foi de 36,2% e 24,5% na primeira e segunda avaliações, respectivamente, e a incidência cumulativa foi de 9,2%. Ademais, 50,3% mantiveram o transtorno entre as avaliações. Durante o pós-parto, aproximadamente 20% das mães apresentaram sintomatologia depressiva ao longo do primeiro ano de vida de seus filhos. A paridade (≥ 2) foi associada ao transtorno mental comum, enquanto a baixa escolaridade materna associou-se com sintoma depressivo pós-parto. Mulheres com transtorno mental comum nas duas avaliações na gravidez apresentaram 5,6 vezes mais chance (IC95% 2,50–12,60) de desenvolverem sintoma depressivo pós-parto. CONCLUSÃO A ocorrência de transtorno mental comum em qualquer momento avaliado durante a gravidez, mas principalmente sua persistência a partir do segundo trimestre, foi fortemente associado ao sintoma depressivo posterior ao parto. Tais achados evidenciam a necessidade de rastreamento precoce e monitoramento da saúde mental de gestantes no início do pré-natal, a fim de reduzir possíveis impactos negativos para a saúde do binômio mãe-filho causados por tais eventos.

    Abstract in English:

    ABSTRACT OBJECTIVE To investigate the occurrence and factors associated with common mental disorders in pregnancy and depressive symptoms in postpartum, as well as the association between both in the Brazilian Western Amazon. METHODS This is a prospective cohort in the MINA-Brazil study with women who received primary health care in the town of Cruzeiro do Sul, Acre State. We performed two clinical evaluations during pregnancy (the first: 16–20 weeks; the second: 28 gestational weeks) and three postpartum evaluations (at 3, 6 and 12 months), in which demographic and socioeconomic, gestational, lifestyle and clinical data were collected. We used the Self-Reported Questionnaire (score ≥ 8) to screen the gestational common mental disorder and the Edinburgh Postnatal Depression Scale (score ≥ 10) to identify postpartum depressive symptoms. We used adjusted ordinal logistic regression to investigate the relationship between the covariates and the occurrence of common mental disorders in pregnancy and postpartum depressive symptomatology. RESULTS A total of 461 women completed the two clinical evaluations in pregnancy; of these, 247 completed the three postpartum evaluations. The occurrence of common mental disorder during pregnancy was 36.2% and 24.5% in the first and second evaluations, respectively, and the cumulative incidence was 9.2%. In addition, 50.3% maintained the disorder between evaluations. During postpartum, approximately 20% of the mothers presented depressive symptoms during the first year of their children’s lives. Parity (≥ 2) was associated with common mental disorders, while low maternal education was associated with postpartum depressive symptoms. Women with a common mental disorder in both evaluations during pregnancy were 5.6 times more likely (95%CI: 2.50–12.60) to develop postpartum depressive symptoms. CONCLUSION The occurrence of common mental disorder at any time assessed during pregnancy, but especially its persistence from the second trimester, was strongly associated with depressive symptoms after childbirth. These findings highlight the need for early screening and monitoring of the mental health of pregnant women at the start of prenatal care in order to reduce possible negative impacts on the health of the mother-child binomial caused by such events.
  • Mortality in Brazilian federal highway police officers: time series from 2001 to 2020 Original Articles

    Marins, Eduardo Frio; Ferreira, Rodrigo Wiltgen; Freitas, Flávio Castagna de; Dutra, Geovana Ferreira de Andrade Alves; Vasconcelos Júnior, José Rossy e; Caputo, Eduardo Lucia

    Abstract in Portuguese:

    RESUMO OBJETIVO Descrever e analisar a tendência de mortalidade, por todas as causas, em agentes da polícia rodoviária federal, entre os anos de 2001 e 2020. MÉTODOS Trata-se de um estudo ecológico de séries temporais, baseado em dados oficiais sobre mortalidade registrados no sistema de cadastro nacional da polícia rodoviária federal e de certidões de óbitos do sistema de cadastro federal. Foram coletados os óbitos de agentes que estavam em efetivo exercício entre 2001 e 2020. Realizou-se análise descritiva, calcularam-se proporções e taxas de incidência por 1.000 policiais. Utilizou-se qui-quadrado para análises bivariadas e regressão de Prais-Winsten para análise de tendência. RESULTADOS Ocorreram 346 óbitos (11 por causas indeterminadas), dos quais 146 foram por mortes naturais e 189 não naturais. A maioria das mortes ocorreu em policiais do sexo masculino (n = 333; 96,3%), acima de 35 anos (n = 265; 76,6%), tempo de serviço até 15 anos (n = 185; 53,5%), da região Nordeste e por causas não naturais (n = 189; 56,4%). O número absoluto de óbitos de agentes apresentou tendência decrescente ao longo da série (p = -0,78; IC95% -1,03 – -0,5). Entre as principais causas de morte estão acidentes de trânsito (n = 96; 28,7%), doenças cardiovasculares (n = 58; 17,3%), violência interpessoal (n = 51; 15,2%), suicídio (n = 35; 10,5%) e neoplasias malignas (n = 35; 10,4%). As mortes naturais predominaram entre os agentes com idade entre 51–73 anos (68,3%; IC95% 58,6–76,7) e mais de 26 anos de serviço (64,7%; IC95% 52,7–75,1), já as não naturais, entre a faixa etária de 19–35 anos (87,3%; IC95% 78,0–93,1) e de até 15 anos de serviço (70,2%; IC95% 63,1–76,4). CONCLUSÕES Conclui-se que a tendência das mortes de agentes da polícia rodoviária federal foi decrescente no período. O conhecimento das causas de mortalidade pode auxiliar no desenvolvimento de políticas de prevenção de doenças e proteção à saúde desses policiais.

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze the mortality trend from all causes in Brazilian federal highway police officers from 2001 to 2020. METHODS This is an ecological time-series study based on mortality official data from the Brazilian federal highway police registry system and death certificates from the federal registry system. Deaths of active police officers from 2001 to 2020 were assessed. We performed a descriptive analysis reporting proportions and incidence rates per 1,000 police officers. The chi-square test was used for bivariate analyzes and Prais-Winsten regression was used for trend analysis. RESULTS Among 346 deaths, 146 were from natural and 189 from unnatural causes (11 were from undefined causes). Most deaths occurred among police officers who were men (n = 333; 96.3%), over 35 years old (n = 265; 76.6%), whose service time was up to 15 years (n = 185; 53.5%), living in Northeast Brazil, and from unnatural causes (n = 189; 56.4%). The absolute number of deaths presented a decreasing trend throughout the series (p = -0.78; 95%CI: -1.03 to -0.5). Traffic accidents (n = 96; 28.7%), cardiovascular diseases (n = 58; 17.3%), interpersonal violence (n = 51; 15.2%), suicides (n = 35; 10.5%), and malignant neoplasms (n = 35; 10.4%) were the main causes of death. Most natural deaths occurred among police officers who were 51–73 years old (68.3%; 95%CI: 58.6 to 76.7) and worked more than 26 years (64.7%; 95%CI: 52.7 to 75.1), while most unnatural deaths occurred among officers who were 19–35 years old (87.3%; 95%CI: 78.0 to 93.1) and worked up to 15 years (70.2%; 95%CI: 63.1 to 76.4). CONCLUSION The mortality trend in Brazilian federal highway police officers decreased within the period studied. Understanding mortality causes may help to develop policies for disease prevention and health protection of police officers.
  • Using routine clinical and administrative data to produce information on mental health in Brazil

    Alves, Flavia Jôse Oliveira; Machado, Daiane Borges; Araujo, Jacyra Azevedo Paiva de; Castro-de-Araujo, Luis Fernando Silva
  • The regulation of artificial intelligence for health in Brazil begins with the General Personal Data Protection Law Comments

    Dourado, Daniel de Araujo; Aith, Fernando Mussa Abujamra

    Abstract in Portuguese:

    RESUMO A inteligência artificial se desenvolve rapidamente e a saúde é uma das áreas em que as novas tecnologias desse campo são mais promissoras. O uso de inteligência artificial tem potencial para modificar a forma de prestação da assistência à saúde e do autocuidado, além de influenciar a organização dos sistemas de saúde. Por isso, a regulação da inteligência artificial na saúde é um tema emergente e essencial. Leis e normas específicas são elaboradas em todo o mundo. No Brasil, o marco inicial dessa regulação é a Lei Geral de Proteção de Dados Pessoais, a partir do reconhecimento do direito à explicação e à revisão de decisões automatizadas. É preciso debater a abrangência desse direito, considerando a necessária instrumentalização da transparência no uso da inteligência artificial na saúde e os limites atualmente existentes, como a dimensão caixa-preta inerente aos algoritmos e o trade-off existente entre explicabilidade e precisão dos sistemas automatizados.

    Abstract in English:

    ABSTRACT Artificial intelligence develops rapidly and health is one of the areas where new technologies in this field are most promising. The use of artificial intelligence can modify the way health care and self-care are provided, besides influencing the organization of health systems. Therefore, the regulation of artificial intelligence in healthcare is an emerging and essential topic. Specific laws and regulations are being developed around the world. In Brazil, the starting point of this regulation is the Lei Geral de Proteção de Dados Pessoais (LGPD – General Personal Data Protection Law), which recognizes the right to explanation and review of automated decisions. Discussing the scope of this right is needed, considering the necessary instrumentalization of transparency in the use of artificial intelligence for health and the currently existing limits, such as the black-box system inherent to algorithms and the trade-off between explainability and accuracy of automated systems.
  • Ultra-processed food consumption by children from a Pelotas Birth Cohort Original Articles

    Pereira, Anna Müller; Buffarini, Romina; Domingues, Marlos Rodrigues; Barros, Fernando Celso Lopes Fernandes; Silveira, Mariângela Freitas da

    Abstract in Portuguese:

    RESUMO OBJETIVO Avaliar o consumo habitual de alimentos ultraprocessados aos 24 meses de idade por crianças pertencentes à Coorte de Nascimentos de Pelotas de 2015 e os principais fatores demográficos, socioeconômicos e comportamentais relacionados ao consumo desses produtos. MÉTODOS Coorte de base populacional na cidade de Pelotas-RS, onde foram avaliadas 4.275 crianças ao nascimento, das quais 95,4% foram acompanhadas até os 24 meses. O consumo alimentar foi avaliado por meio de um questionário de consumo habitual de alimentos ultraprocessados, coletando informações sobre sexo, renda familiar, cor da pele, escolaridade e idade da mãe, frequentar creche, ter irmãos, status de amamentação e obesidade. O desfecho foi a somatória de alimentos ultraprocessados consumidos habitualmente pela criança. Análise multivariada por regressão de Poisson foi utilizada para estimar a associação entre consumo habitual de alimentos ultraprocessados e as variáveis de exposição. RESULTADOS O número médio de alimentos ultraprocessados consumidos habitualmente foi de 4,8 (DP = 2,3). O consumo habitual de alimentos ultraprocessados foi associado positivamente à cor da pele preta e ter irmãos e negativamente associado com renda familiar, escolaridade e idade materna. CONCLUSÕES A média de consumo habitual de alimentos ultraprocessados por crianças pertencentes à Coorte de Nascimentos de 2015 da cidade de Pelotas é elevada, o que pode causar um efeito negativo na dieta das crianças. O risco de consumo desses alimentos foi maior entre crianças de famílias de menor posição socioeconômica, filhas de mães de baixa escolaridade, de cor da pele preta, mais jovens e de baixa renda.

    Abstract in English:

    ABSTRACT OBJECTIVE Assessing the regular consumption of ultra-processed foods by children at 24 months of age from the 2015 Pelotas Birth Cohort and the main demographic, socioeconomic, and behavioral factors related to the consumption of these products. METHODS Population-based cohort in the city of Pelotas, RS, where 4,275 children were assessed at birth and 95.4% of them were followed up until 24 months of age. Food consumption was assessed by a questionnaire on regular consumption of ultra-processed foods, which collected information regarding sex, household income, maternal skin color, schooling level, and age, the child attending day care and having siblings, breastfeeding status, and obesity. The outcome was the sum of ultra-processed foods regularly consumed by a child. A multivariate Poisson regression analysis was used to calculate the association between the regular consumption of ultra-processed foods and exposure variables. RESULTS The mean number of ultra-processed foods consumed was 4.8 (SD = 2.3). The regular consumption of ultra-processed foods was positively associated with black skin color and having siblings, and negatively associated with household income and maternal schooling level and age. CONCLUSION The mean regular consumption of ultra-processed foods by children from the 2015 Pelotas Birth Cohort is high, which can negatively affect the children’s diet. The risk of consuming this kind of food was higher among children from families of lower socioeconomic status, whose mothers present lower education level, black skin color, and younger age.
  • Limits and possibilities for the development of public health research in the legal system Original Articles

    Andrade, Nayla Rochele Nogueira de; Nunes, Carlos Francisco Oliveira; Albuquerque, Felipe Braga; Araújo, Carmem E. Leitão; Ferreira, Anderson Fuentes; Reis, Adriana da Silva dos; Ramos Jr., Alberto Novaes

    Abstract in Portuguese:

    RESUMO OBJETIVO Caracterizar as bases de dados dos tribunais de justiça do Brasil como potencial ferramenta para a pesquisa em Saúde Coletiva em suas interfaces com as ciências jurídicas. MÉTODOS Estudo transversal de natureza quantitativa e descritiva com foco em análise de gestão estratégica e sistemas judiciários. RESULTADOS Foram identificadas e analisadas bases de dados utilizadas pela Justiça Comum nas Unidades da Federação para sistematizar processos judiciais. Verificou-se um total de 123 bases de dados nos tribunais de justiça por unidade de federação, com destaque para as regiões Sul e Nordeste, em contraste à região Norte que apresenta menor número de sistemas. Esse grande número de sistemas judiciais limita o acesso a operadores do direito, e dificulta levantamento de evidências por pesquisadores em saúde e, consequentemente, com impactos na gestão estratégica do Poder Executivo. Constatou-se limitações desde o design à extração transparente e democrática de dados pelos próprios usuários, bem como restrita integração entre bases. CONCLUSÕES Embora avanços tenham sidos empreendidos nos últimos anos pelos tribunais de justiça para unificação dessas bases, a multiplicidade de sistemas de informação utilizados na Justiça Comum estadual complexifica a gestão do conhecimento, limita o desenvolvimento de pesquisas, mesmo quando realizados por advogados ou pesquisadores da área jurídica, gera lentidão na extração de dados para a gestão pública. Reconhece-se a necessidade de esforços adicionais para a padronização, bem como para aprimoramento dessas bases de dados, ampliando acesso, transparência e integração com vistas a um olhar transdisciplinar entre o campo do Direito e da Saúde Coletiva.

    Abstract in English:

    ABSTRACT OBJECTIVE To characterize databases of the courts of justice of Brazil as a potential tool for research in Collective Health, in its interface with the legal sciences. METHODS Cross-sectional study of quantitative and descriptive nature, focusing on analysis of strategic management and judicial systems. RESULTS Databases used by the Common Justice in the Federation Units to systematize judicial processes were identified and analyzed. A total of 123 databases were found in the courts of justice per state, with emphasis on the South and Northeast regions, in contrast to the North region, which has a smaller number of systems. This large number of judicial systems limits access to legal operators, and hinders the collection of evidence by health researchers and, consequently, impacts the strategic management of the Executive Branch. There were limitations from design to transparent and democratic data extraction by the users themselves, as well as restricted integration between bases. CONCLUSIONS Although advances have been made in recent years by the courts of justice to unify these databases, the multiplicity of information systems used in the Common State Justice complicates the management of knowledge, limits the development of research, even when carried out by lawyers or researchers in the legal area, as well as generates slow data extraction for public management. It is recognized the need for additional efforts for standardization, as well as for improvement of these databases, expanding access, transparency and integration with a view to a transdisciplinary look between the field of Law and Collective Health.
  • My Exposure to Violence: translation and cultural adaptation to the BR Portuguese Original Articles

    Carvalho, Marcos Clint Leal de; Macena, Raimunda Hermelinda Maia

    Abstract in Portuguese:

    RESUMO OBJETIVO Traduzir e adaptar para português brasileiro o instrumento de aferição de exposição à violência comunitária, My Exposure to Violence. MÉTODOS Estudo psicométrico de tradução e adaptação transcultural em sete etapas: (I) traduções iniciais, (II) síntese das traduções, (III) retrotraduções, (IV) pré-adaptação transcultural, (V) avaliação por comitê de juízes, (VI) pré-teste e (VII) submissão ao autor original. Na etapa V oito juízes avaliaram a equivalência de conteúdo do instrumento, sendo calculado o índice de validade de conteúdo para cada item (IVC-I) e para a média do instrumento (IVC-M), considerando-se um IVC-I ≥ 0,78 como excelente e um IVC-M ≥ 0,80 como aceitável e ≥ 0,90 como excelente. O pré-teste foi realizado com 39 adolescentes matriculados em uma instituição de ensino em Fortaleza, no Ceará, sendo avaliada a compreensibilidade dos itens. RESULTADOS Na etapa I, duas traduções foram produzidas, com poucas diferenças entre si. Estas foram dirimidas na etapa II, gerando a versão síntese (T12). Na etapa III, os itens retrotraduzidos refletiram o mesmo conteúdo dos itens da versão original. Na etapa IV, ocorreu a revisão de T12 pelos autores, que realizaram modificações linguísticas específicas, de modo a facilitar o entendimento. Na etapa V, um item (22) apresentou IVC < 0,78. Devido a pertinência das sugestões, 19 dos 23 itens (82,60%) sofreram modificações. O IVC-M do instrumento foi 0,92. Na etapa VI, a média de idade dos participantes foi de 17,48 anos (DP = 1,27). A versão pré-final teve 21 dos 23 itens (91,30%) totalmente compreendidos por mais de 90% dos participantes. Não foram realizadas alterações na versão final. CONCLUSÕES O My Exposure to Violence foi adaptado transculturalmente para o português brasileiro, tendo sido bem compreendido pela população alvo. Outras propriedades psicométricas, como confiabilidade e validade, devem ser avaliadas em estudos posteriores para fortalecer as evidências da versão traduzida e adaptada.

    Abstract in English:

    ABSTRACT OBJECTIVE To translate and adapt the My Exposure to Violence instrument for measuring exposure to community violence into Brazilian Portuguese. METHODS Psychometric study of translation and cross-cultural adaptation in seven stages: (I) initial translations, (II) synthesis of translations, (III) back-translations, (IV) cross-cultural pre-adaptation, (V) evaluation by committee of judges, (VI) pre-test, and (VII) submission to the original author. In step V eight judges evaluated the instrument’s equivalence of content, and the content validity index was calculated for each item (CVI-I) and for the average of the instrument (CVI-M), considering a CVI-I ≥ 0.78 as excellent and a CVI-M ≥ 0.80 as acceptable and ≥ 0.90 as excellent. The pre-test was conducted with 39 adolescents enrolled in an educational institution in Fortaleza, state of Ceará. The understandability of the items was evaluated. RESULTS In step I, two translations were produced with few differences between them. These were resolved in step II, by generating the synthesis version (T12). In step III, the back-translated items reflected the same content as the items in the original version. In step IV, T12 was revised by the authors, who made specific linguistic changes in order to facilitate understanding. In step V, one item (22) presented CVI < 0.78. Due to the relevance of the suggestions, 19 of the 23 items (82.60%) were modified. The CVI-M of the instrument was 0.92. In stage VI, the mean age of the participants was 17.48 years (SD = 1.27). The pre-final version had 21 out of 23 items (91.30%) fully understood by more than 90% of the participants. No changes were made to the final version. CONCLUSIONS My Exposure to Violence was cross-culturally adapted into Brazilian Portuguese, and was well understood by the target population. Other psychometric properties, such as reliability and validity, should be evaluated in further studies to strengthen the evidence of the translated and adapted version.
  • Instrument for measuring home cooking skills in primary health care Original Articles

    Teixeira, Aline Rissatto; Camanho, Júlia Souza Pinto; Miguel, Flavia da Silva; Mega, Helena Carvalho; Slater, Betzabeth

    Abstract in Portuguese:

    RESUMO OBJETIVO Desenvolver e validar instrumento para mensuração de habilidades culinárias domésticas de profissionais de saúde envolvidos com orientações de promoção da alimentação adequada e saudável da atenção primária à saúde. MÉTODOS Estudo metodológico com abordagem psicométrica, realizado no município de São Paulo entre janeiro e novembro de 2020, para desenvolvimento e validação de instrumento on-line autoaplicável. Os dados dos 472 participantes foram apresentados por estatística descritiva. A validação de conteúdo foi realizada por julgamento de especialistas utilizando técnica Delphi de dois rounds e estatísticas empíricas para evidência de consenso. Empregou-se análise fatorial exploratória para validação de constructo e análise de confiabilidade, analisados índices de ajuste do modelo e fidedignidade composta. RESULTADOS O instrumento apresentou validade de conteúdo satisfatória para índices de CVRc e nos dois rounds da técnica Delphi. Após análise fatorial, o modelo final da Escala de Habilidades Culinárias Domésticas da Atenção Primária à Saúde apresentou 29 itens com cargas fatoriais adequadas (> 0,3). Os testes de esfericidade de Bartlett e Kaiser-Meyer-Olkin (KMO) realizados em análise fatorial exploratória sugeriram interpretabilidade na matriz de correlação, a análise paralela indicou quatro domínios e variância explicada de 64,1%. A fidedignidade composta dos fatores foi adequada (> 0,70) e o índice H sugeriu fatores replicáveis em estudos futuros. Todos os índices de ajustes mostraram-se adequados. CONCLUSÕES A Escala de Habilidades Culinárias Domésticas da Atenção Primária à Saúde apresentou evidências de validade e confiabilidade. É curta e de fácil aplicação e possibilitará a averiguação de forma fidedigna da necessidade de qualificação da força de trabalho, favorecendo o planejamento de ações e políticas públicas de promoção da alimentação adequada e saudável na atenção primária à saúde.

    Abstract in English:

    ABSTRACT OBJECTIVE To develop and validate an instrument for measuring the home cooking skills of health professionals involved with guidelines for promoting adequate and healthy food in primary health care. METHODS This is a methodological study with a psychometric approach, carried out in the city of São Paulo between January and November 2020, to develop and validate a self-applied online instrument. The data of the 472 participants were presented by descriptive statistics. Content validation was performed by expert judgment using the two round Delphi technique and empirical statistics for consensus evidence. Exploratory factor analysis was used for construct validation and reliability analysis, and the model adjustment rates and composite reliability were analyzed. RESULTS The instrument presented satisfactory content validity for CVRc indices and in the two rounds of the Delphi technique. After the factor analysis, the final model of the Primary Health Care Home Cooking Skills Scale presented 29 items with adequate factorial loads (> 0.3). Bartlett’s and Kaiser-Meyer-Olkin’s (KMO) tests of sphericity performed in exploratory factorial analysis suggested interpretability in the correlation matrix, the parallel analysis indicated four domains and explained variance of 64.1%. The composite reliability of the factors was adequate (> 0.70) and the H-index suggested replicable factors in future studies. All adjustment rates proved to be adequate. CONCLUSIONS The Primary Health Care Home Cooking Skills Scale presented evidence of validity and reliability. It is short and easy to apply and will make it possible to reliably ascertain the need for qualification of the workforce, favoring the planning of actions and public policies of promotion of adequate and healthy food in primary health care.
  • Three decades of household food availability according to NOVA - Brazil, 1987–2018 Original Articles

    Levy, Renata Bertazzi; Andrade, Giovanna Calixto; Cruz, Gabriela Lopes da; Rauber, Fernanda; Louzada, Maria Laura da Costa; Claro, Rafael Moreira; Monteiro, Carlos Augusto

    Abstract in Portuguese:

    RESUMO OBJETIVO Avaliar a tendência da aquisição domiciliar de alimentos de acordo com a classificação NOVA no Brasil entre 1987–1988 e 2017–2018. MÉTODOS Foram utilizados dados de aquisição domiciliar de alimentos provenientes de cinco edições da Pesquisas de Orçamentos Familiares, realizada pelo Instituto Brasileiro de Geografia e Estatística, nos anos 1987–1988, 1995–1996, 2002–2003, 2008–2009 e 2017–2018. Todos os alimentos reportados foram categorizados segundo a classificação NOVA. A disponibilidade domiciliar dos grupos e subgrupos de alimentos foi expressa por meio de sua participação (%) nas calorias totais, para o conjunto das famílias brasileiras, por situação do domicílio (urbana ou rural), para cada uma das cinco regiões geográficas do país, por quintos da distribuição de renda domiciliar per capita (inquéritos de 2002–2003, 2008–2009 e 2017–2018); e para as 11 principais regiões urbanas do país (inquéritos de 1987–1988, 1995–1996, 2002–2003, 2008–2009 e 2017–2018). Modelos de regressão linear foram utilizados para avaliar a tendência de aumento ou diminuição na aquisição dos alimentos. RESULTADOS A dieta da população brasileira ainda é composta predominantemente por alimentos in natura e minimamente processados e ingredientes culinários processados. No entanto, nossos achados apontam tendências de aumento da participação de alimentos ultraprocessados na dieta. Esse aumento que foi de 0,4 pontos percentuais ao ano na primeira porção do período estudado, entre 2002 e 2009, e desacelerou para 0,2 pontos percentuais entre 2008 e 2018. O consumo de alimentos ultraprocessados foi maior entres os domicílios de maior renda, nas regiões Sul e Sudeste, na área urbana, e nas regiões metropolitanas. CONCLUSÃO Os resultados do presente estudo apontam um aumento na participação de alimentos ultraprocessados na dieta dos brasileiros. Cenário preocupante, uma vez que o consumo de tais alimentos está associado ao desenvolvimento de doenças e à perda da qualidade nutricional da dieta.

    Abstract in English:

    ABSTRACT OBJECTIVE To evaluate the trend of household food acquisition according to the NOVA classification in Brazil between 1987–1988 and 2017–2018. METHODS We used household food acquisition data from five editions of the Pesquisas de Orçamentos Familiares (Household Budget Surveys), conducted by the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics), in the years 1987–1988, 1995–1996, 2002–2003, 2008–2009, and 2017–2018. All reported foods were categorized according to the NOVA classification. The household availability of food groups and subgroups was expressed through their share (%) in total calories, for all Brazilian families, by household situation (urban or rural), for each of the five geographic regions of the country, by fifths of the household income per capita distribution (2002–2003, 2008–2009 and 2017–2018 surveys), and for the 11 main urban regions of the country (1987–1988, 1995–1996, 2002–2003, 2008–2009 and 2017–2018 surveys). Linear regression models were used to assess the trend of increasing or decreasing food purchases. RESULTS The diet of the Brazilian population is still composed predominantly of foods in natura or minimally processed and processed culinary ingredients. However, our findings point to trends of increasing share of ultra-processed foods in the diet. This increase of 0.4 percentage points per year between 2002 and 2009 slowed down to 0.2 percentage points between 2008 and 2018. The consumption of ultra-processed food was higher among households with higher income, in the South and Southeast regions, in urban areas, and in metropolitan regions. CONCLUSION Our results indicate an increase in the share of ultra-processed foods in the diet of Brazilians. This is a worrisome scenario, since the consumption of such foods is associated with the development of diseases and the loss of nutritional quality of the diet.
  • Blessing as a health resource: cross-sectional study with elderly residents of rural areas Original Articles

    Jesien, Stephanie; Marmitt, Luana Patrícia; Meucci, Rodrigo Dalke

    Abstract in Portuguese:

    RESUMO OBJETIVO Estimar a prevalência e os fatores associados à procura de benzedeiras para tratamento de problemas de saúde entre idosos residentes na área rural do município do Rio Grande-RS. MÉTODOS Estudo transversal, de base populacional com amostragem aleatória, realizado no ano de 2017. O desfecho foi analisado em três categorias (nunca usou/usou nos últimos 12 meses/usou há mais de 12 meses). Para análise dos fatores associados foi utilizada regressão logística multinomial. RESULTADOS Foram entrevistados 1.030 idosos. As prevalências da procura por benzedeira nos últimos 12 meses e há mais de 12 meses foram de 9,5% e 15,8%, respectivamente. Na análise ajustada, as características associadas à utilização de benzedeira há mais de 12 meses foram: estar na faixa etária de 80 anos ou mais e ter problemas de coluna e artrose. Seguir a religião evangélica foi identificado como fator de proteção para a utilização desse recurso. Já a procura por benzedeira no último ano esteve relacionada com a faixa etária dos 70–79 anos, seguir religiões espiritualistas, presença de doença nos últimos 12 meses, problemas na coluna e artrose e preferência por utilização de serviços de urgência e emergência. Sexo feminino permaneceu associado apenas à utilização há mais de 12 meses. CONCLUSÃO Este estudo traz uma contribuição original a um tema pouco avaliado em estudos epidemiológicos, pois o conhecimento da frequência e dos determinantes da busca por esse tipo de terapia popular, pode ser utilizado para melhorar a qualidade e o acesso aos serviços de saúde oferecidos à população idosa de áreas rurais.

    Abstract in English:

    ABSTRACT OBJECTIVE To estimate the prevalence and factors associated with the search for folk healers for the treatment of health problems among elderly living in the rural area of the city of Rio Grande-RS. METHODS Cross-sectional, p opulation-based study with random sampling, carried out in 2017. The outcome was analyzed in three categories (never used/used in the last 12 months/used for more than 12 months). Multinomial logistic regression was used to analyze theassociated factors. RESULTS A total of 1,030 elderly individuals were interviewed. The prevalence of demand for folk healers in the last 12 months and for more than 12 months was 9.5% and 15.8%, respectively. In the adjusted analysis, the characteristics associated with the use of a folk healer for more than 12 months were: being in the age group of 80 years or more and having back problems and arthrosis. Following the evangelical religion was identified as a protective factor for using this resource. On the other hand, the demand for blessing in the last year was related to the age group of 70–79 years, following spiritual religions, presence of disease in the last 12 months, back problems and arthrosis, and preference for the use of urgency and emergency services. Being female was associated only with the use for more than 12 months. CONCLUSION This study brings an original contribution to a topic poorly evaluated in epidemiological studies, because the knowledge of the frequency and determinants of the search for this type of popular therapy can be used to improve the quality and access to health services offered to the elderly population in rural areas.
  • Different remote realities: health and the use of territory in Brazilian rural municipalities Original Articles

    Bousquat, Aylene; Fausto, Márcia Cristina Rodrigues; Almeida, Patty Fidelis de; Lima, Juliana Gagno; Seidl, Helena; Sousa, Amandia Braga Lima; Giovanella, Ligia

    Abstract in Portuguese:

    RESUMO OBJETIVO Caracterizar os municípios rurais remotos brasileiros segundo suas lógicas de inserção na dinâmica socioespacial, discutindo as implicações dessas características para as políticas de saúde. MÉTODOS Partindo da categoria de análise – o uso do território – elaborou-se uma tipologia, com delimitação de seis clusters . Os clusters foram comparados a partir de dados socioeconômicos e da distância em minutos para a metrópole, capital regional e centro sub-regional. Foram calculados a média, o erro padrão e o desvio padrão das variáveis quantitativas e realizados testes de diferenças de média. RESULTADOS Os seis clusters identificados aglutinam 97,2% dos municípios rurais remotos e foram denominados de: Matopiba; Norte de Minas; vetor Centro-Oeste; Semiárido; Norte Águas; e Norte Estradas. Observam-se diferenças entre os clusters nas variáveis analisadas, indicando a existência de distintas realidades. Os municípios rurais remotos dos clusters Norte Água e Norte Estrada são os mais populosos, mais extensos e distam milhares de quilômetros de centros urbanos, enquanto os do Norte de Minas e do Semiárido tem áreas menores com distância de cerca de 200 km. Por outro lado, os municípios rurais remotos do vetor Centro-Oeste se diferem por uma economia dinâmica, inserida no circuito econômico mundial devido à presença do agronegócio. A Estratégia de Saúde da Família é o modelo predominante na organização da atenção primária à saúde. CONCLUSÃO Os municípios rurais remotos distinguem-se em suas características socioespaciais e de inserção na lógica econômica, demandando políticas de saúde customizadas. A estratégia de construção das regiões de saúde, com oferta de serviços regionais especializados, tende a ser mais efetiva nos municípios rurais remotos mais próximos de centros urbanos, desde que articulada à política de transporte sanitário. O uso de tecnologia de informação e ampliação do escopo das atividades de telessaúde é mandatório para enfrentamento das distâncias em cenários como esse. A atenção primária à saúde integral com forte componente cultural é peça-chave para garantir o direito à saúde para os cidadãos que aí residem.

    Abstract in English:

    ABSTRACT OBJECTIVE To characterize remote rural Brazilian municipalities according to their logic of insertion into socio-spatial dynamics, discussing the implications of these characteristics for health policies. METHODS Starting from the category of analysis – the use of the territory – a typology was elaborated, with the delimitation of six clusters. The clusters were compared using socioeconomic data and the distance in minutes to the metropolis, regional capital, and sub-regional center. Mean, standard error and standard deviation of the quantitative variables were calculated, and tests on mean differences were performed. RESULTS The six clusters identified bring together 97.2% of remote rural municipalities and were called: “Matopiba,” “Norte de Minas,” “Vetor Centro-Oeste,” “Semiárido,” “Norte Águas,” and “Norte Estradas.” Differences are observed between the clusters in the analyzed variables, indicating the existence of different realities. Remote rural municipalities of “Norte Águas” and “Norte Estradas” clusters are the most populous, the most extensive and are thousands of kilometers away from urban centers, while those in “Norte de Minas” and “Semiárido” clusters have smaller areas with a distance of about 200 km away from urban centers. The remote rural municipalities of the “Vetor Centro-Oeste” cluster, in turn, are distinguished by a dynamic economy, inserted into the world economic circuit due to the agribusiness. The Family Health Strategy is the predominant model in the organization of primary health care. CONCLUSION Remote rural municipalities are distinguished by their socio-spatial characteristics and insertion into the economic logic, demanding customized health policies. The strategy of building health regions, offering specialized regional services, tends to be more effective in remote rural municipalities closer to urban centers, as long as it is articulated with the health transportation policy. The use of information technology and expansion of the scope of telehealth activities is mandatory to face distances in such scenarios. Comprehensive primary health care with a strong cultural component is key to guaranteeing the right to health for citizens residing in such regions.
  • Factors associated with common mental disorders among farmers in a medium-sized municipality in Northeastern Brazil Original Articles

    Alves, Roberta Machado; Santos, Emelynne Gabrielly de Oliveira; Barbosa, Isabelle Ribeiro

    Abstract in Portuguese:

    RESUMO OBJETIVO Identificar a prevalência e os fatores associados aos transtornos mentais comuns entre agricultores residentes em um município de médio porte no nordeste do Brasil, entre 2019 e 2020. MÉTODOS Entrevistadoras treinadas aplicaram o questionário padronizado em 450 participantes. Investigou-se características sociodemográficas, de saúde, renda e trabalho. O rastreamento dos transtornos mentais comuns foi realizado mediante a utilização do questionário SRQ-20 ( Self-Reporting Questionaire ), com o ponto de corte ≥ 7 para mulheres e ≥ 5 para homens. Foi aplicada a regressão de Poisson com estimação robusta para verificar as razões de prevalência na análise bivariada e multivariada. RESULTADOS A prevalência dos transtornos mentais comuns entre agricultores foi de 55,1% (IC95% 50,4–59,6). As variáveis que permaneceram significativas e associadas aos transtornos mentais comuns foram: ser do sexo masculino (RP = 1,7), ter mais de 60 anos (RP = 0,5), ter autoavaliação de saúde ruim ou muito ruim (RP = 1,4), ter realizado tratamento anterior para saúde mental (RP = 1,2), fazer uso abusivo do álcool (RP = 1,2) e ter tido perda de produção (RP = 1,3). CONCLUSÃO Esses resultados indicam que os transtornos mentais comuns estão associados a fatores individuais e do contexto de vida e trabalho dos agricultores, o que demonstra a importância do suporte social, econômico e dos serviços de saúde a esse grupo de trabalhadores.

    Abstract in English:

    ABSTRACT OBJECTIVE To identify the prevalence and factors associated with common mental disorders among farmers living in a medium-sized municipality in Northeastern Brazil between 2019 and 2020. METHODS Trained interviewers applied the standardized questionnaire in 450 participants. Sociodemographic, health, income and working characteristics were assessed. The screening of common mental disorders was performed using the Self-Reporting Questionaire, with the cutoff point ≥ 7 for women and ≥ 5 for men. Poisson regression with robust estimation was applied to verify the prevalence ratios in the bivariate and multivariate analysis. RESULTS The prevalence of common mental disorders among farmers was 55.1% (95%CI: 50.4–59.6). The variables that remained significant and associated with common mental disorders were: men (PR = 1.7), > 60 years old (PR = 0.5), poor or very poor self-assessment of health (PR = 1.4), previous mental health treatment (PR = 1.2), alcohol abuse (PR = 1.2) and loss of production (PR = 1.3). CONCLUSION These results indicate that common mental disorders are associated with individual factors and with the farmers’ context of life and work, which shows the importance of social, economic and health services support to this group of workers.
  • Harassment of health professionals by the infant food industry at scientific events Original Articles

    Velasco, Ana Carla da Cunha Ferreira; Oliveira, Maria Inês Couto de; Boccolini, Cristiano Siqueira

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar o recebimento de patrocínios da indústria de substitutos do leite materno por profissionais de saúde em eventos científicos. MÉTODOS Inquérito multicêntrico (Multi-NBCAL) conduzido entre novembro de 2018 e novembro de 2019 em seis cidades de diferentes regiões brasileiras. Em 26 hospitais públicos e privados foram entrevistados pediatras, nutricionistas, fonoaudiólogos e um membro da chefia, mediante questionário estruturado. Foram realizadas análises descritivas do conhecimento dos profissionais de saúde sobre a Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeiras (NBCAL), das empresas patrocinadoras de eventos científicos e dos patrocínios financeiros ou materiais recebidos, conforme a categoria profissional. RESULTADOS Foram entrevistados 217 profissionais de saúde, principalmente pediatras (48,8%). Pouco mais da metade dos profissionais (54,4%) afirmaram conhecer a NBCAL, principalmente em Hospitais Amigos da Criança. A maior parte (85,7%) dos profissionais de saúde havia participado de congressos científicos nos últimos dois anos, mais da metade, 54,3%, deles apoiados pela indústria de substitutos do leite materno, em especial pela Nestlé (85,1%) e Danone (65,3%). Patrocínios foram recebidos por esses profissionais nos eventos, como materiais de escritório (49,5%), refeições ou convites para festas (29,9%), brindes (21,6%), pagamento de inscrição (6,2%) ou de passagem para o congresso (2,1%). CONCLUSÃO As indústrias de alimentos infantis infringem a NBCAL ao assediar profissionais de saúde em congressos científicos, oferecendo patrocínios materiais e financeiros diversos.

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze the receipt of sponsorships from breast-milk substitute companies by health professionals in scientific events. METHODS Multicenter study (Multi-NBCAL) performed from November 2018 to November 2019 in six cities in different Brazilian regions. In 26 public and private hospitals, pediatricians, nutritionists, speech therapists, and a hospital manager were interviewed using a structured questionnaire. Descriptive analyses were carried out regarding the health professionals’ knowledge about the Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeiras (NBCAL – Brazilian Code of Marketing of Infant and Toddlers Food and Childcare-related Products), companies sponsoring scientific events, and material or financial sponsorships received, according to profession. RESULTS We interviewed 217 health professionals, mainly pediatricians (48.8%). Slightly more than half of the professionals (54.4%) knew NBCAL, most from Baby-friendly Hospitals. Most health professionals (85.7%) attended scientific events in the last two years, more than half of them (54.3%) sponsored by breast-milk substitute companies, especially Nestlé (85.1%) and Danone (65.3%). These professionals received sponsorships in the events, such as office supplies (49.5%), meals or invitations to parties (29.9%), promotional gifts (21.6%), payment of the conference registration fee (6.2%) or ticket to the conference (2.1%). CONCLUSION The infant food industries violate NBCAL by harassing health professionals in scientific conferences, offering diverse material and financial sponsorships.
  • Prevalence of multimorbidity in older adults in São Paulo, Brazil: a study with ISA-Capital Original Articles

    Keomma, Kaio; Bousquat, Aylene; César, Chester Luiz Galvão

    Abstract in Portuguese:

    RESUMO OBJETIVO Estimar a prevalência de multimorbidade em idosos em São Paulo, Brasil. MÉTODOS Estudo transversal, aninhado ao inquérito de base populacional ISA-Capital, de 2015, com sub amostra de 1.019 idosos com 60 anos ou mais. A multimorbidade foi categorizada considerando duas ou mais doenças crônicas, a partir de uma lista previamente definida. Os dados foram analisados em modelos univariado e múltiplo com a regressão de Poisson. RESULTADOS A prevalência de multimorbidade foi de 40% (IC95% 36,6–43,8), sendo maior nas mulheres (RP a = 1,95 [comparado com homens]; IC95% 1,58–2,40), nos indivíduos com 75 anos ou mais (RP a = 1,25 [comparado com indivíduos de 60 a 64 anos]; IC95% 1,01–1,60), nos pretos (RP a = 1,28 [comparado com brancos]; IC95% 1,04–1,59), nas pessoas de alta renda (RP a = 1,27 [comparado com baixa renda]; IC95% 1,09–1,50) e nos ex-fumantes (RP a = 1,30 [comparado com quem nunca fumou]; IC95% 1,05–1,60) e menor nos que se declararam fumantes (RP a = 0,72 [comparado com quem nunca fumou]; IC95% 1,09–1,50). CONCLUSÕES A prevalência de multimorbidade foi inferior à reportada na maioria dos estudos revisados, mas há consistência sobre sua associação com sexo, idade, cor da pele, tabagismo e nível socioeconômico. A padronização de critérios conceituais e metodológicos para a sua estimação é um desafio para mitigar problemas no planejamento e gestão de sistemas de saúde para populações cada vez mais envelhecidas.

    Abstract in English:

    ABSTRACT OBJECTIVE To estimate the prevalence of multimorbidity in older adults in São Paulo, Brazil. METHODS A cross-sectional study based on the 2015 ISA-Capital population-based survey, with a subsample of 1,019 older adults aged ≥ 60 years old. Multimorbidity was categorized considering two or more chronic diseases, based on a previously defined list. The data were analyzed in univariate and multiple models with Poisson regression. RESULTS The prevalence of multimorbidity was 40% (95%CI: 36.6–43.8), being higher in women (PR a = 1.95 [compared to men]; 95%CI: 1.58–2.40), in individuals aged ≥ 75 years old (PR a = 1.25 [compared to individuals aged ≥ 60 to 64 years old]; 95%CI: 1.01–1.60), in Black people (PR a = 1.28 [compared to White people]; 95%CI: 1.04–1.59), in high-income people (PR a = 1.27 [compared to low income]; 95%CI: 1.09–1.50) and in former smokers (PR a = 1.30 [compared to those who never smoked]; 95%CI: 1.05–1.60), and lower in smokers (PR a = 0.72 [compared to those who never smoked]; 95%CI: 1.09–1.50). CONCLUSION The prevalence of multimorbidity was lower than that reported in most of the reviewed studies, but consistently associated with gender, age, race/skin color, smoking habit and socioeconomic status. The standardization of conceptual and methodological criteria for estimation is a challenge to relieve problems in the planning and management of health care systems for older populations.
  • The role of skin-to-skin contact in exclusive breastfeeding: a cohort study Original Articles

    Goudard, Marivanda Julia Furtado; Lamy, Zeni Carvalho; Marba, Sérgio Tadeu Martins; Lima, Geisy Maria de Souza; Santos, Alcione Miranda dos; Vale, Marynea Silva do; Ribeiro, Talyta Garcia da Silva; Costa, Roberta; Azevedo, Vivian Mara Gonçalves de Oliveira; Lamy-Filho, Fernando

    Abstract in English:

    ABSTRACT OBJETIVE To understand the role of exposure to skin-to-skin contact and its minimum duration in determining exclusive breastfeeding at hospital discharge in infants weighing up to 1,800g at birth. METHODS A multicenter cohort study was carried out in five Brazilian neonatal units. Infants weighing ≤ 1,800g at birth were eligible. Skin-to-skin contact time was recorded by the health care team and parents on an individual chart. Maternal and infant data was obtained from maternal questionnaires and medical records. The Classification Tree, a machine learning method, was used for data analysis; the tree growth algorithm, using statistical tests, partitions the dataset into mutually exclusive subsets that best describe the response variable and calculates appropriate cut-off points for continuous variables, thus generating an efficient explanatory model for the outcome under study. RESULTS A total of 388 infants participated in the study, with a median of 31.6 (IQR = 29–31.8) weeks of gestation age and birth weight of 1,429g (IQR = 1,202–1,610). The exclusive breastfeeding rate at discharge was 61.6%. For infant’s weighting between 1,125g and 1,655g, exposed to skin-to-skin contact was strongly associated with exclusive breastfeeding. Moreover, infants who made an average > 149.6 min/day of skin-to-skin contact had higher chances in this outcome (74% versus 46%). In this group, those who received a severity score (SNAPPE-II) equal to zero increased their chances of breastfeeding (83% versus 63%). CONCLUSION Skin-to-skin contact proved to be of great relevance in maintaining exclusive breastfeeding at hospital discharge for preterm infants weighing 1,125g–1,655g at birth, especially in those with lower severity scores.
  • Factors associated with sleep problems and sleeping pill use in Brazilians Original Articles

    Araújo, Mayonara Fabíola Silva; Souza, Talita Araújo de; Medeiros, Arthur de Almeida; Souza, Jane Carla de; Barbosa, Isabelle Ribeiro

    Abstract in Portuguese:

    RESUMO OBJETIVO Estimar a prevalência e fatores associados a problemas de sono e uso de medicamentos para dormir na população brasileira. MÉTODOS Estudo executado com os dados da Pesquisa Nacional de Saúde realizada no Brasil, nos anos de 2019 e 2020. A amostra foi composta por 94.114 participantes e os desfechos analisados foram problemas de sono e uso de medicamentos para dormir. Aspectos sociodemográficos, de estilo de vida e condições de saúde foram explorados em uma análise descritiva e multivariada, utilizando a regressão de Poisson com variância robusta, considerando nível de significância de 5%. RESULTADOS As prevalências de problemas de sono e uso de medicamentos indutores do sono foram de 35,1% (IC95% 34,5–35,7) e 8,5% (IC95% 8,2–8,9), respectivamente. Os problemas de sono foram associados ao sexo feminino (RP = 1,41; IC95% 1,36–1,46), aos indivíduos que autoavaliam a saúde como regular/ruim/muito ruim (RP = 1,56; IC95% 1,51–1,62), aos que possuem alguma doença crônica (RP = 1,70; IC95% 1,64–1,78), aos que fazem uso excessivo de álcool (RP = 1,14; IC95% 1,09–1,20) e aos fumantes (RP = 1,16; IC95% 1,10–1,22). O uso de medicamentos para dormir foi associado ao sexo feminino (RP = 1,57; IC95% 1,43–1,73), a indivíduos divorciados (RP = 1,46; IC95% 1,30–1,65), aos que vivem no meio urbano (RP = 1,32; IC95% 1,21–1,45), que autoavaliam sua saúde como regular/ruim/muito ruim (RP = 1,79; IC95% 1,64–1,95), com diagnóstico de doença crônica (RP = 4,07; IC95% 3,48–4,77) e aos fumantes (RP = 1,49; IC95% 1,33–1,67). CONCLUSÃO As prevalências de problemas de sono e uso de medicamentos para dormir na população brasileira observadas neste estudo indicam a necessidade de atenção e cuidado com o sono dessa população, principalmente nas mulheres e aqueles que apresentam estilo de vida e condições de saúde que se associaram aos desfechos.

    Abstract in English:

    ABSTRACT OBJECTIVE To estimate the prevalence of sleep problems and sleeping pill use and associated factors in the Brazilian population. METHODS This study was conducted with data from the 2019 Brazilian National Health Survey. Our sample consisted of 94,114 participants and the outcomes analyzed were sleep problems and sleeping pill use. Sociodemographic, lifestyle, and health characteristics were explored in a descriptive and multivariate analysis with Poisson regression, robust variance, and 5% significance. RESULTS We found a 35.1% (95%CI: 34.5–35.7) and 8.5% (95%CI: 8.2–8.9) prevalence of sleep problems and sleeping pill use, respectively. Sleep problems were associated with women (PR = 1.41; 95%CI: 1.36–1.46), individuals who self-assess their health as regular/poor/very poor (PR = 1.56; 95%CI: 1.51–1.62), those with chronic diseases (PR = 1.70; 95%CI: 1.64–1.78), those who use alcohol excessively (PR = 1.14; 95%CI: 1.09–1.20), and smokers (PR = 1.16; 95%CI: 1.10–1.22). Sleeping pill use was associated with women (PR = 1.57; 95%CI: 1.43–1.73), divorcees (PR = 1.46; 95%CI: 1.30–1.65), urban denizens (PR = 1.32; 95%CI: 1.21–1.45) those who self-assess their health as regular/poor/very poor (PR = 1.79; 95%CI: 1.64–1.95), those with chronic diseases (PR = 4.07; 95%CI: 3.48–4.77), and smokers (PR = 1.49; IC95%: 1.33–1.67). CONCLUSION This study found that the prevalence of sleep problems and sleeping pill use in Brazilians indicates the need for attention and sleep care for this population, especially in women and those with lifestyle and health conditions associated with the analyzed outcomes.
  • The influence of protective psychosocial factors on the incidence of dental pain Original Articles

    Alvarenga, Mariana Guimarães Jorge de; Rebelo, Maria Augusta Bessa; Lamarca, Gabriela de Almeida; Paula, Janice Simpson de; Vettore, Mario Vianna

    Abstract in Portuguese:

    RESUMO OBJETIVO Investigar a influência de fatores psicossociais protetores sobre a incidência de dor dentária nos últimos seis meses em crianças de 12 anos residentes em Manaus (AM). MÉTODOS Um estudo de coorte prospectivo de base escolar foi realizado com 210 alunos de 12 anos, matriculados em escolas públicas da zona leste de Manaus (AM) que foram acompanhados por dois anos. Questionários validados foram usados para avaliar características sociodemográficas, fatores psicossociais protetores, incluindo senso de coerência, apoio social e autoestima na linha de base e após dois anos. Examinadores calibrados avaliaram clinicamente cárie dentária e sangramento gengival. Regressão de Poisson multinível multivariada foi usada para estimar o risco relativo (RR) e o intervalo de confiança de 95% (IC95%) entre a variação dos escores dos fatores psicossociais e a incidência de dor dentária, ajustada para os escores dos fatores psicossociais na linha de base, plano de saúde odontológico, frequência de escovação dentária e cárie dentária. RESULTADOS As médias dos escores do senso de coerência e do apoio social reduziram significativamente entre linha de base e seguimento de dois anos. A incidência de dor dentária no seguimento de dois anos foi 28,6%. O risco de dor dentária foi 14% maior para cada 10 pontos na redução média do escore do senso de coerência (RR = 1,14; IC95% 1,02–1,20), e 6% maior para cada 10 pontos na redução média do escore do apoio social (RR = 1,06; IC95% 1,01–1,11). A mudança na autoestima não foi associada ao risco de dor dentária. CONCLUSÃO A variação do senso de coerência e do apoio social no período de dois anos influenciou a incidência de dor dentária em crianças, sugerindo que fatores psicossociais protetores, comportamentos em saúde, plano odontológico e a condição clínica bucal desempenham um papel importante na incidência da dor dentária.

    Abstract in English:

    ABSTRACT OBJECTIVE To investigate the influence of protective psychosocial factors on the incidence of dental pain in the last six months among 12-year-old children living in Manaus (AM). METHODS A prospective school-based cohort study was conducted with 210 12-year-old students enrolled in public schools in the eastern zone of Manaus (AM). Students were followed up for two years. Validated questionnaires were used to assess sociodemographic characteristics, protective psychosocial factors, including sense of coherence, social support, and self-esteem at baseline and after two years. Calibrated examiners clinically assessed dental caries and gingival bleeding. Multivariate multilevel Poisson regression was used to estimate the relative risk (RR) and 95% confidence interval (95%CI) between the changes on psychosocial factors scores and incidence of dental pain, adjusted for psychosocial factors scores at baseline, dental health insurance, frequency of tooth brushing, and dental caries. RESULTS Mean scores for sense of coherence and social support reduced significantly from baseline to 2-year follow-up. The incidence of dental pain along the two-year follow-up was 28.6%. The risk of dental pain was 14% higher for every 10 points in the mean reduction of sense of coherence score (RR = 1.14; 95%CI: 1.02–1.20), and 6% higher for every 10 points of the mean reduction in social support score (RR = 1.06; 95%CI: 1.01–1.11). Change on self-esteem was not associated with risk of dental pain. CONCLUSION Change on sense of coherence and social support over the two-year period influenced the incidence of dental pain among children, suggesting that protective psychosocial factors, health behaviours, dental health insurance, and clinical oral condition have an important role in the incidence of dental pain.
  • Would the Brazilian population support the alcohol policies recommended by the World Health Organization? Original Articles

    De Boni, Raquel B.; Mota, Jurema C.; Coutinho, Carolina; Bastos, Francisco I.

    Abstract in English:

    ABSTRACT OBJECTIVE To evaluate the support of the Brazilian population to the alcohol-policies proposed by the World Health Organization to decrease alcohol harm (specifically: to decrease alcohol availability and advertising, and to increase pricing). In addition, we evaluated the factors associated with being against those policies. METHODS Data from 16,273 Brazilians, aged 12–65 years, interviewed in the 3rd Brazilian Household Survey on Substance Use (BHSU-3) were analyzed. The BHSU-3 is a nationwide, probability survey conducted in 2015. Individuals were asked if they would be against, neutral, or in favor of seven alcohol policies grouped as: 1) Strengthen restrictions on alcohol availability; 2) Enforce bans or restrictions on alcohol advertising, sponsorship, and promotion; and 3) Raise prices on alcohol through excise taxes and pricing. Generalized linear models were fitted to evaluate factors associated with being against each one of those policies and against all of policies. RESULTS Overall, 28% of the Brazilians supported all the above mentioned policies, whereas 16% were against them. The highest rate of approval refers to restricting advertising (53%), the lowest refers to increasing prices (40%). Factors associated with being against all policies were: being male (AOR = 1.1; 95%CI: 1.0–1.3), not having a religion (AOR = 1.4; 95%CI: 1.1–1.8), being catholic (AOR = 1.3; 95%CI: 1.1–1.5), and alcohol dependence (AOR = 1.6; 95%CI: 1.1–2.4). CONCLUSIONS The Brazilian government could count on the support of most of the population to restrict alcohol advertising. This information is essential to tackle the lobby of the alcohol industry and its clever marketing strategy.
  • Daytime sleepiness in elementary school students: the role of sleep quality and chronotype Original Articles

    Anacleto, Tâmile Stella; Borgio, João Guilherme Fiorani; Louzada, Fernando Mazzilli

    Abstract in English:

    ABSTRACT OBJECTIVE To investigate the occurrence of daytime sleepiness and associated sleep factors in a sample of elementary school students who attended school in the afternoon schedule. METHODS Sleep data from 363 Brazilian public school students (12.78 ± 1.36 years, 206 girls) were obtained by applying questionnaires in classrooms. All subjects attended school in the afternoon schedule, with classes starting between 1:00 and 1:20 p.m. Daytime sleepiness was assessed by the pediatric daytime sleepiness scale; sleep quality, by the mini-sleep questionnaire; and sleep patterns and chronotypes, by the Munich chronotype questionnaire. Scores equal to or greater than 15 pediatric daytime sleepiness scale points were considered as excessive daytime sleepiness. The predictive power of sleep variables on daytime sleepiness was evaluated by a multiple linear regression. RESULTS The subjects in the sample had an average time in bed greater than nine hours both on school days and on weekends. Nevertheless, 52.1% had an average pediatric daytime sleepiness scale score equal to or greater than 15 points, indicative of excessive daytime sleepiness. As for their quality of sleep, 41.1% had a very altered sleep. We observed, by a multiple linear regression, that quality of sleep (β = 0.417), chronotype (β = 0.174), mid-sleep on school days (β = 0.138), and time in bed (β = - 0.091) were all significant in predicting daytime sleepiness. CONCLUSION This study showed the occurrence of excessive daytime sleepiness in non-sleep deprived students who attended school in the afternoon. The worst quality of sleep and eveningness had a greater predictive power on daytime sleepiness than time in bed. Therefore, we must consider other factors in addition to sleep duration when planning interventions for daytime sleepiness.
  • Barriers to the access of people with disabilities to health services: a scoping review Review

    Clemente, Karina Aparecida Padilha; Silva, Simone Vieira da; Vieira, Gislene Inoue; Bortoli, Maritsa Carla de; Toma, Tereza Setsuko; Ramos, Vinícius Delgado; Brito, Christina May Moran de

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar as evidências científicas relativas às barreiras para o acesso de pessoas com deficiência aos serviços de saúde. MÉTODOS Realizou-se uma revisão de escopo estabelecendo-se a perguntanorteadora: “Quais são as principais barreiras que as pessoas com deficiência enfrentam no acesso a serviços de saúde?” O levantamento dos artigos foi realizado em julho de 2019, em seis bases de dados de literatura científica. Dos 1.155 documentos identificados nas buscas, após seleção por título e resumo, foram lidas na íntegra 170 publicações e, após leitura, 96 artigos foram incluídos e categorizados conforme referencial teórico. RESULTADOS As principais barreiras indicadas pelos usuários do serviço foram: comunicação falha entre profissionais e paciente/cuidador; limitações financeiras; questões atitudinais/comportamentais; oferta de serviços escassa; barreiras organizacionais e de transporte. As principais barreiras apresentadas pelos prestadores de serviços foram: falta de treinamento/capacitação aos profissionais; falha do sistema de saúde; barreiras físicas; falta de recursos/tecnologia e barreiras de idioma. CONCLUSÕES Ficou evidente que as pessoas com deficiência enfrentam diversas barreiras ao tentarem acesso aos serviços de saúde de que necessitam e que usuários e profissionais de saúde têm visões distintas e complementares sobre as dificuldades.

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze the scientific evidence regarding barriers to the access of people with disabilities to health services. METHODS A scoping review was carried out from the main question: “What are the main barriers that people with disabilities face in accessing health services?” The articles were surveyed in July 2019 in six scientific literature databases. Of the 1,155 documents identified in the searches, after selection by title and abstract, 170 publications were read in full and, thus, 96 articles were included and categorized according to the theoretical framework. RESULTS The main barriers indicated by the users of the service were: communication failure between professionals and patient/caregiver; financial limitations; attitudinal/behavioral issues; scarce service provision; organizational and transport barriers. The main barriers presented by service providers were: lack of training to professionals; failure of the health system; physical barriers; lack of resources/technology; and language barriers. CONCLUSIONS It was evident that people with disabilities face several barriers when trying to access the health services they need and that users and health professionals have distinct and complementary views on difficulties.
  • Mortality attributed to sickle cell disease in children and adolescents in Brazil, 2000–2019 Original Articles

    Nascimento, Maria Isabel do; Przibilski, Ana Luísa Ferreira; Coelho, Carolina Sampaio Gomes; Leite, Katyslaine Frossard de Amorim; Makenze, Mariana; Jesus, Stella Bayer de

    Abstract in Portuguese:

    RESUMO OBJETIVO Estimar taxas e descrever tendências de mortalidade atribuídas à doença falciforme em crianças e adolescentes no Brasil, de 2000 a 2019. MÉTODOS Este é um estudo ecológico do tipo séries temporais de taxas de mortalidade que usou o método autorregressivo, proposto por Prais-Winsten, para avaliar tendências das taxas estimadas de mortes por doença falciforme em crianças e adolescentes no Brasil. Os óbitos com código D57 foram obtidos no Sistema de Informações sobre Mortalidade, considerando as faixas etárias (0–4, 5–9, 10–14, 15–19 anos) e usados para estimar taxas específicas por idade e taxas padronizadas por sexo e idade. RESULTADOS De 2000 a 2019, houve 2.422 óbitos por doença falciforme em menores de 20 anos no Brasil, com maior frequência na região Nordeste (40,46%), seguida de Sudeste (39,02%), Centro-Oeste (9,58%), Norte (7,84%) e Sul (3,10%). As principais vítimas foram pessoas de raça/cor da pele negra (78,73%). No Brasil, a taxa média padronizada global foi de 0,20/100 mil pessoa-ano, com tendência de elevação (mudança percentual anual – APC = 5,44%; intervalo de confiança – IC95% 2,57–8,39). O padrão se repetiu no sexo masculino (APC = 4,38%; IC95% 2,17–6,64) e no sexo feminino (APC = 6,96%; IC95% 3,05–11,01). A elaboração de taxas específicas por idade mostrou que a faixa até quatro anos experimentou as maiores taxas, sem distinção por região. A faixa etária de 15 e 19 anos foi a segunda mais afetada no Brasil e nas regiões Nordeste, Sudeste e Centro-Oeste. CONCLUSÃO Houve tendência de aumento dos óbitos por transtornos falciformes em crianças e adolescentes. Considerando que a magnitude dos óbitos foi mais evidente nos primeiros anos (0–4) e no final da adolescência (15–19), o estudo sugere que abordagens específicas por faixa etária podem impactar no controle dos desfechos fatais causados pela doença falciforme no Brasil.

    Abstract in English:

    ABSTRACT OBJECTIVE Estimate rates and describe mortality trends attributed to sickle cell disease in children and adolescents in Brazil from 2000 to 2019. METHODS This is an ecological study of the time-trend of mortality rates that used the autoregressive method, proposed by Prais-Winsten, to evaluate trends in the estimated rates of sickle cell disease deaths in children and adolescents in Brazil. Deaths with code D57 were obtained from the Mortality Information System, considering age groups (0–4, 5–9, 10–14, 15–19 years) and were used to estimate age-specific and standardized rates by gender and age. RESULTS From 2000 to 2019, Brazil had 2,422 deaths from sickle cell disease in people under 20 years of age, with higher frequency in the Northeast (40.46%), followed by the Southeast (39.02%), Midwest (9.58%), North (7.84%), and South (3.10%). The main victims were people of Black skin/race (78.73%). In Brazil, the global standardized average rate was 0.20/100,000 people-year, with an elevation trend (annual percentage change – APC = 5.44%; confidence interval – 95%CI: 2.57–8.39). The pattern was repeated in males (APC = 4.38%; 95%CI: 2.17–6.64) and females (APC = 6.96%; 95%CI: 3.05–11.01). Elaborating age-specific rates showed that the range up to four years experienced the highest rates, without distinction by region. The age group of 15 and 19 years was the second most affected in Brazil and in the Northeast, Southeast, and Midwest regions. CONCLUSION Deaths due to sickle cell disorders showed an elevation trend in children and adolescents. Considering that the magnitude of deaths was more evident in the first years (0–4) and late adolescence (15–19), the study suggests that age-specific approaches may impact the control of fatal outcomes caused by sickle cell disease in Brazil.
  • Race in public health dentistry: a critical review of the literature Review

    Reginaldo, Isabela; Fernandes, Isabelle Aparecida Monteiro; Nuernberg, Giulia Nicoladeli; Bastos, João Luiz

    Abstract in English:

    ABSTRACT OBJECTIVE To carry out a critical review of the literature on the use of race, color, and ethnicity in the field of public health dentistry. METHODS A literature search was conducted in MEDLINE via PubMed for articles published between 2014 and 2019. Using a data extraction form, we collected information on (1) bibliographic characteristics of the selected papers; (2) race, color, and ethnicity of the study participants and their sociodemographic profiles; and (3) the extent to which the original publications followed the recommendations by Kaplan and Bennett (2003) on the use of race, color, or ethnicity in biomedical research. RESULTS Our initial search identified 2,032 articles, 53 of which were selected for full-text examination and assessment following pre-established eligibility criteria. Around 60% (n = 32) of the included studies did not justify the use of race, color, or ethnicity in their analyses, and 9% (n = 5) took these variables as indicators of the participants’ genetic makeup. On the other hand, 68% (n = 36) of the reviewed papers considered race, color, and ethnicity as risk markers – not risk factors – for adverse oral health outcomes, whereas 80% (n = 42) adjusted racial/ethnic inequities for a range of socioeconomic and demographic factors in statistical models. Only one study (2%) explicitly took race, color, or ethnicity as a contextually dependent dimension of the participants’ identities. CONCLUSION Our findings indicate that research on oral health inequities is often based on reductionist and stigmatizing conceptions of race, color, or ethnicity. Such harmful misconceptions should be replaced with anti-racist narratives in order to effectively address racial oral health inequities.
  • Reproductive health practices and use of health services among immigrant Indonesian women working in Malaysia Original Articles

    Sutan, Rosnah; Siregar, Pinta Pudiyanti

    Abstract in English:

    ABSTRACT OBJECTIVE To describe the reproductive health practices of immigrant Indonesian women working in Malaysia and their accessibility to health services. METHODS A cross-sectional study using a validated self-administered questionnaire was conducted with 593 immigrant Indonesian workers who stayed in Malaysia for at least six months and within the reproductive age group. RESULTS About 13.5% of the respondents have used health facilities for reproductive health-related problems. Less than half of the respondents preferred to use public health facilities. Only 15% used treatment available in health facilities related to irregular menstrual cycles (34.6%), severe dysmenorrhea (58.7%) and nonspecific symptoms related to menstruation (31.7%). Family planning services were the most required health service. However, only 31.5% met the needs for family planning services. One-third of the respondents had sexual reproductive health problems and required treatment, but only 9.9% sought reproductive health services when needed. CONCLUSIONS Strategies to improve the accessibility to sexual reproductive health services requires a collaboration between the Indonesian government representatives in Malaysia and non-governmental organizations to address the reproductive health issues among immigrant Indonesian women in Malaysia. Health policy related to immigrant workers is needed in order to enhance the accessibility to women’s health needs for universal health coverage.
  • Covid-19 pandemic impacts on follow-up of child growth and development Original Articles

    Andrade, Gisele Nepomuceno de; Matoso, Leonardo Ferreira; Silva, Tércia Moreira Ribeiro da; Beinner, Mark Anthony; Romano, Márcia Christina Caetano; Vieira, Ed Wilson Rodrigues

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze the impact of the covid-19 pandemic on the use of primary health care services to follow-up the child growth and development in Brazil. METHOD A total of 7.9 million consultations of children (0–2 years old) across Brazil between March 2017 and May 2020 were studied. Differences between medians were analyzed using non-parametric tests, the Global Moran Index (IGM) and the Local Indicators of Spatial Association. RESULTS During the initial period of the pandemic, the median number of consultations was significantly lower than the same period in previous years, reducing more than 50%. The drop in 2020, compared to 2019, ranged from 49% to 62.2% across all regions of the country, except the South. The percentage reduction registered in 2019–2020 showed significant spatial autocorrelation (IGM = 0.20; p = 0.04), with the presence of low-low (states with reduction between 29% and 51%) and high-high (states with reduction between 55% and 69%) spatial clusters. CONCLUSION The covid-19 pandemic impacted the follow-up of child growth and development in primary health care services in Brazil, with a geographically uneven reduction.
  • Association of social factors and health conditions with capacity and performance Original Articles

    Barreto, Marina Carvalho Arruda; Cartes-Velásquez, Ricardo; Campos, Valeria; Araújo, Larissa Fortunato; Castro, Shamyr Sulyvan de

    Abstract in English:

    ABSTRACT OBJECTIVE Determine and measure the association of social factors and health conditions with worse capacity and performance levels. METHODS Dependent variables consisted of performance and capacity; independent variables comprised age, gender, level of education, personal income, and health conditions. Means (95%CI) of performance and capacity were presented according to the independent variables. Generalized linear models, using a mutual adjustment for all variables considered statistically significant (p < 0.05), measured the associations between each exposure and outcomes. Study population included 12,265 individuals. RESULTS Older women with lower education and income levels and with some health condition showed the worst performance and capacity. CONCLUSION Results showed that the capacity and performance levels of the Chilean population changed according to social demographic characteristics and health conditions.
  • Factors associated with HIV/syphilis co-infection initiating of antiretroviral therapy Original Articles

    Simões, Luana Andrade; Mendes, Jullye Campos; Silveira, Micheline Rosa; Costa, André Moura Gomes da; Lula, Mariana Dias; Ceccato, Maria das Graças Braga

    Abstract in Portuguese:

    RESUMO OBJETIVO Avaliar a prevalência e os fatores associados à coinfecção HIV/sífilis em pessoas no início da terapia antirretroviral no município de Belo Horizonte, Minas Gerais. MÉTODOS Foi realizado um corte seccional de um estudo de coorte prospectivo, com pessoas vivendo com HIV, sem tratamento prévio da infecção, em início da terapia antirretroviral, maiores de 16 anos e em acompanhamento em serviços de assistência especializada em HIV/aids de Belo Horizonte. Dados sociodemográficos, comportamentais, clínicos, laboratoriais e relacionados ao tratamento farmacológico foram obtidos por meio de entrevistas, coleta em prontuários clínicos e nos sistemas de informação de controle de medicamentos antirretrovirais e exames laboratoriais. A variável dependente foi o primeiro episódio de sífilis ativa, registrado pelo médico em prontuário clínico, em um período de 12 meses após início da terapia antirretroviral. Os fatores associados à coinfecção HIV/sífilis foram avaliados por meio de regressão logística binária múltipla. RESULTADOS Dentre os 459 indivíduos avaliados, observou-se uma prevalência de 19,5% (n = 90) de infecções sexualmente transmissíveis, sendo a sífilis (n = 49) a infecção sexualmente transmissível mais frequente nesses indivíduos. A prevalência da coinfecção HIV/sífilis foi de 10,6% (n = 49) e os fatores independentes associados foram o uso de álcool (OR = 2,30; IC95% 1,01–5,26) e ter diagnóstico de outras infecções sexualmente transmissíveis (OR = 3,33; IC95% 1,24–8,95). CONCLUSÕES Houve alta prevalência de coinfecção HIV/sífilis em pessoas vivendo com HIV em início de terapia antirretroviral em Belo Horizonte. A coinfecção HIV/sífilis foi associada a fatores comportamentais e clínicos, como uso de álcool e diagnóstico de outras infecções sexualmente transmissíveis. O conhecimento prévio sobre os fatores associados à essa coinfecção pode subsidiar as decisões dos profissionais de saúde inseridos no cuidado às pessoas vivendo com HIV, no que diz respeito ao diagnóstico oportuno, orientações, acompanhamento e tratamento adequado, tanto da sífilis quanto do HIV.

    Abstract in English:

    ABSTRACT OBJECTIVE To evaluate the prevalence and factors associated with HIV/syphilis co-infection in people initiating antiretroviral therapy in Belo Horizonte, capital of the state of Minas Gerais. METHODS A sectional section of a prospective cohort study was carried out with people living with HIV, treatment-naive, initiating antiretroviral therapy, older than 16 years, and in follow-up treatment at specialized HIV/Aids care services in Belo Horizonte. Sociodemographic, behavioral, clinical, laboratory and pharmacological treatment-related data were obtained through interviews, medical records, and information systems for logistical control of antiretroviral medications and laboratory tests. The dependent variable was the first episode of active syphilis, recorded by the physician in clinical records, within 12 months after beginning of the antiretroviral therapy. Factors associated with HIV/syphilis co-infection were assessed using binary multiple logistic regression. RESULTS Among the 459 individuals included, a prevalence of 19.5% (n = 90) of sexually transmitted infections (STI) was observed, with syphilis (n = 49) being the most frequent STI in these individuals. The prevalence of HIV/syphilis co-infection was 10.6% (n = 49), and the associated independent factors were alcohol use (OR = 2.30; 95%CI: 1.01–5.26), and having a diagnosis of other sexually transmitted infections (OR = 3.33; 95%CI: 1.24–8.95). CONCLUSIONS There was a high prevalence of HIV/syphilis co-infection in people living with HIV initiating antiretroviral therapy in Belo Horizonte. HIV/syphilis co-infection was associated with behavioral and clinical factors, such as alcohol use and diagnosis of other sexually transmitted infections. Prior knowledge about the factors associated with this co-infection may support the decisions of health professionals engaged in the care to people living with HIV, with regard to timely diagnosis, guidance, follow-up and adequate treatment, both for syphilis and HIV.
  • Public policy coverage and access to medicines in Brazil Original Articles

    Moraes, Ricardo Montes de; Santos, Maria Angelica Borges dos; Vieira, Fabiola Sulpino; Almeida, Rosimary Terezinha de

    Abstract in Portuguese:

    RESUMO OBJETIVO Descrever padrões de consumo de medicamentos com e sem desembolso direto de recursos, segundo faixas de idade e de renda, destacando os fármacos associados a programas de saúde com garantias específicas de acesso. MÉTODOS Estudo descritivo observacional usando microdados da Pesquisa de Orçamentos Familiares (POF/IBGE) 2017–2018. Inicialmente, foram definidas as garantias específicas de acesso a medicamentos do SUS pela sistematização de programas/políticas com essa previsão. A partir dos medicamentos do quadro 29 do questionário de despesas individuais (POF-4), foram selecionados tipos de medicamentos associados a essas garantias. Foram descritas as frequências e os percentuais de pessoas sem consumo e com consumo (aquisição com e sem desembolso direto de recursos), segundo faixas de idade e de renda. Para medicamentos vinculados a garantias específicas, comparou-se valores médios mensais de aquisições e padrões de consumo por faixa etária e renda. RESULTADOS Entre as pessoas com renda domiciliar até dois salários mínimos, 63% não declararam consumo de medicamentos no mês. Entre as acima de 25 salários mínimos, foram 44,3%. Aquisições sem desembolso direto foram feitas principalmente por pessoas na faixa com até 10 salários mínimos e entre os mais idosos. O consumo sem desembolso direto representou 20,5% do consumo total de medicamentos (em valor). Para políticas com garantias específicas de acesso, o consumo sem desembolso foi de 33,6% com variações desse percentual entre os medicamentos selecionados no estudo: vacinas, 83,3%; medicamentos para câncer, 70,3%; diabetes, 47,9%; hipertensão, 35,9%; asma e bronquite, 29,2%; problemas oftalmológicos, 14%; medicamentos para próstata e vias urinárias, 10,7%; para problemas ginecológicos, 11,6%; e anticoncepcionais, 9,7%. CONCLUSÃO O consumo sem desembolso ainda é baixo, mas beneficia principalmente pessoas de menor renda e idosos. Políticas e programas com garantias específicas de acesso a medicamentos têm aumentado esse acesso. Os resultados sugerem a necessidade de fortalecer e ampliar as políticas de assistência farmacêutica.

    Abstract in English:

    ABSTRACT OBJECTIVE Describe consumption patterns for monetary and non-monetary acquisition of medicines according to age and income groups, highlighting pharmaceuticals associated with health programs with specific access guarantees. METHODS Descriptive observational study using microdata from the 2017–2018 Pesquisa de Orçamentos Familiares (Household Budget Survey, POF/IBGE). We initially reviewed programs/policies with specific guarantees of access to medicines in the SUS. Using the pharmaceutical product list of POF-4 (chart 29 of the questionnaire on individual expenditures), we selected the medicines related to these programs. We then described frequencies and percentages for not reporting medicine consumption and for reporting consumption (either through monetary or non-monetary acquisition) according to age and income groups. For medicines with distinctive access guarantees, we compared average monthly values of acquisitions and consumption patterns by age and income. RESULTS 63% of those in the ≤ 2 minimum wage (MW) household income group did not report consuming medicines in the last month. Among those earning > 25 MW, 44.3% did not report consumption. Non-monetary acquisitions of medicines were mainly reported for the < 10 MW group and for the elderly and accounted for 20.5% of the total consumption of medicines (in value). For policies with specific access guarantees, non-monetary acquisitions reached 33.6% of total consumption. This percentage varied for the various selected medicines: vaccines, 83.3%; cancer drugs, 70.3%; diabetes, 47.9%; hypertension, 35.9%; asthma and bronchitis, 29.2%; eye problems, 14%; prostate and urinary tract, 10.7%; gynecological, 11.6%; and contraceptives, 9.7%. CONCLUSION Shares for non-monetary acquisitions of medicines are still low but benefit mainly lower-income and older age groups. Policies and programs with specific access guarantees to medicines have increased access. Results suggest the need to strengthen and expand pharmaceutical care policies.
  • Panorama of risky sexual behaviors in the Brazilian adult population – PNS 2019 Original Articles

    Gomes, Nayara Lopes; Lopes, Claudia de Souza

    Abstract in Portuguese:

    RESUMO OBJETIVO Descrever os comportamentos sexuais de risco dos adultos brasileiros segundo características socioeconômicas, demográficas e regionais. MÉTODOS Foram analisados dados da Pesquisa Nacional de Saúde 2019, referente à população de 18 anos de idade ou mais. Considerou-se como comportamentos sexuais de risco: a iniciação sexual precoce, antes dos 15 anos, e o não uso de preservativo na última relação sexual. Foram calculadas as prevalências e respectivos intervalos de confiança para os subgrupos de interesse. RESULTADOS A iniciação sexual precoce entre indivíduos adultos foi de 24% entre os homens e 11% entre as mulheres, sendo mais alta entre jovens com menores níveis de instrução e rendimento domiciliar. O não uso de preservativo se mostrou maior entre os casados/coabitantes, sem instrução ou com nível fundamental incompleto, e entre os mais velhos. A prevalência do não uso de preservativo entre casados/coabitantes foi igual em ambos os sexos (75%). No entanto, entre os não coabitantes, a disparidade entre os sexos se mostrou relevante uma vez que 39,1% das mulheres não usaram preservativo na última relação sexual, enquanto entre os homens esse resultado foi de 26,9%. CONCLUSÃO Nota-se, especialmente entre as mulheres, maiores prevalências de iniciação sexual precoce para as gerações mais novas. No que se refere ao não uso de preservativo, há disparidades de sexo importantes no grupo dos não coabitantes, além da alta prevalência entre os mais velhos, que devem ser consideradas na elaboração das políticas públicas. Os resultados do presente estudo são extremamente relevantes para compreensão da população adulta atualmente mais vulnerável às infecções sexualmente transmissíveis, após mais de cinco anos sem estatísticas oficiais a respeito em âmbito nacional.

    Abstract in English:

    ABSTRACT OBJECTIVE To describe the risky sexual behaviors of Brazilian adults according to socioeconomic, demographic, and regional characteristics. METHODS Data from the 2019 National Health Survey, referring to the population aged 18 years or older, were analyzed. Risky sexual behaviors were considered: early sexual initiation, before the age of 15 years, and nonuse of condoms in the last sexual intercourse. Prevalence and respective confidence intervals were calculated for the subgroups of interest. RESULTS Early sexual initiation among adult individuals was 24% among men and 11% among women, being higher among young people with lower levels of education and household income. The nonuse of condoms was higher among married/cohabiting partners, no schooling or with some elementary school, and among older people. The prevalence of nonuse of condoms among married/cohabiting partners was the same in both sexes (75%). However, among non-cohabiting partners, gender disparity was relevant, as 39.1% of women did not use condoms in the last sexual intercourse, while among men this result was 26.9%. CONCLUSIONS Higher prevalence of early sexual initiation for younger generations is noteworthy, especially among women. Concerning the nonuse of condoms, there are important gender disparities in the group of non-cohabiting partners, in addition to the high prevalence among older people, which should be considered in the formulation of public policies. The results of the present study are extremely relevant for understanding the adult population currently more vulnerable to sexually transmitted infections, after over five years without official statistics on this matter at the national level.
  • Barriers faced by patients in the diagnosis of multidrug-resistant tuberculosis in Brazil Original Articles

    Bhering, Marcela; Dalcolmo, Margareth; Sarubbi Júnior, Vicente; Kritski, Afrânio

    Abstract in English:

    ABSTRACT OBJECTIVE To understand patients’ narratives about the barriers they faced in the diagnosis and treatment of multidrug-resistant tuberculosis, and their consequences in Rio de Janeiro State, Brazil. METHODS This is a qualitative cross-sectional study with non-probabilistic sampling. A theoretical saturation criterion was considered for composing the number of interviewees. Semi-structured interviews were conducted from August to December 2019 with 31 patients undergoing treatment for multidrug-resistant tuberculosis at an outpatient referral center in Rio de Janeiro. Data were transcribed and processed with the aid of the NVIVO software. Interviews were evaluated by content analysis, and their themes, cross-referenced with participants’ characterization data. RESULTS Our main findings were: a) participants show a high proportion of primary drug resistance, b) patients experience delays in the diagnosis and effective treatment of multidrug-resistant tuberculosis ; c) healthcare providers fail to value or seek the diagnosis of drug-resistant tuberculosis, thus beginning the inadequate treatment for drug-susceptible tuberculosis, d) primary health units show low report rates of active case-finding and contact monitoring, and e) patients show poor knowledge about the disease. CONCLUSIONS We need to improve referral systems, and access to the diagnosis and effective treatment of multidrug-resistant tuberculosis; conduct an active investigation of contacts; intensify the training of healthcare providers, in collaboration with medical and nursing schools, in both public and private systems; and promote campaigns to educate the population on tuberculosis signs and symptoms.
  • Yellow fever vaccination before and during the covid-19 pandemic in Brazil Original Articles

    Silva, Tércia Moreira Ribeiro da; Nogueira de Sá, Ana Carolina Micheletti Gomide; Prates, Elton Junio Sady; Rodrigues, Daiana Elias; Silva, Thales Philipe Rodrigues da; Matozinhos, Fernanda Penido; Vieira, Ed Wilson Rodrigues

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze the number of yellow fever vaccine doses administered before and during the covid-19 pandemic in Brazil. METHODS This is an ecological, time series study based on data from the National Immunization Program. Differences between the median number of yellow fever vaccine doses administered in Brazil and in its regions before (from April/2019 to March/2020) and after (from April/2020 to March/2021) the implementation of social distancing measures in the country were assessed via the Mann-Whitney test. Prais-Winsten regression models were used for time series analyses. RESULTS We found a reduction in the median number of yellow fever vaccine doses administered in Brazil and in its regions: North (-34.71%), Midwest (-21.72%), South (-63.50%), and Southeast (-34.42%) (p < 0.05). Series showed stationary behavior in Brazil and in its five regions during the covid-19 pandemic (p > 0.05). Brazilian states also showed stationary trends, except for two states which recorded an increasing trend in the number of administered yellow fever vaccine doses, namely: Alagoas State (before: β = 64, p = 0.081; after: β = 897, p = 0.039), which became a yellow fever vaccine recommendation zone, and Roraima State (before: β = 68, p = 0.724; after: β = 150, p = 0.000), which intensified yellow fever vaccinations due to a yellow fever case confirmation in a Venezuelan State in 2020. CONCLUSION The reduced number of yellow fever vaccine doses administered during the covid-19 pandemic in Brazil may favor the reemergence of urban yellow fever cases in the country.
  • Factors related to healthcare costs of road traffic accidents in Bucaramanga, Colombia Original Articles

    Rivera-Carvajal, Raquel; Páez-Esteban, Astrid Nathalia; Torres-Contreras, Claudia Consuelo; Esquiaqui-Felipe, Rafael Enrique; González, Nixon Ricardo; Mejía-Muñoz, Claudia Celmira

    Abstract in Spanish:

    RESUMEN OBJETIVO Determinar los factores relacionados con los costos generales durante la atención en salud de siniestros de tránsito en Bucaramanga, Colombia. MÉTODOS Estudio descriptivo, transversal, con análisis de registros de siniestros de tránsito durante 2019 en Bucaramanga, Colombia. Se realizó una comparación entre cuartiles de los costos en dólares con pruebas estadísticas de Chi-cuadrado de Pearson y exacta de Fisher. También, se calcularon odds ratio en regresión logística. RESULTADOS En 2019 se registraron 3.150 siniestros, con 7.038 personas involucradas, de los cuales 812 tenían información de costos generados por atención en instituciones de salud. La mediana de costos fue US$ 56,59 (RI = 29,35–140,15), promedio de US$ 290,11 ± 731,22 (IC95% 239,74–340,48). Se observó mayor posibilidad para estar en cuartil 4 de los costos si la persona tenía menos de 18 años (OR = 4,88; IC95% 1,30–18,32) o entre los 46–60 años de edad (OR = 3,66; IC95% 1,01–13,30), cuando el tipo de vehículo es la motocicleta (OR = 2,79; IC95% 1,25–6,24) y la bicicleta (OR = 7,66; IC95% 2,70–21,68), si la lesión ocurre en la cabeza (OR = 4,50; IC95% 2,61–7,76) y si la hipótesis está relacionada con embriaguez (OR = 12,44; IC95% 2,01–76,87). CONCLUSIÓN Los factores relevantes en los costos fueron la motocicleta, bicicleta, lesión en la cabeza, ser menor de 18 años o tener entre los 46 años y los 60 años y embriaguez como hipótesis. Es relevante implementar medidas de prevención según los factores identificados para disminuir la accidentalidad y, por ende, sus costos socioeconómicos.

    Abstract in English:

    ABSTRACT OBJECTIVE To determine the factors related to overall healthcare costs of road traffic accidents in Bucaramanga, Colombia. METHODS A descriptive cross-sectional study was conducted through the analysis of road traffic accident records that took place in 2019 in Bucaramanga, Colombia. Cost quartiles in dollars were compared using Pearson’s chi-squared and Fisher’s exact tests. Odds ratios were also calculated in logistic regression. RESULTS 3,150 road accidents were reported in 2019 involving 7,038 people, of which 812 had information related to healthcare costs in health care institutions. The median cost was 56.59 USD (RI = 29.35–140.15), average cost of 290.11 USD ± 731.22 (95%CI: 239.74–340.48). A higher possibility to be in the 4th quartile was found when persons were under 18 years of age (OR = 4.88; 95%CI: 1.30–18.32) or 46–60 years (OR = 3.66; 95%CI: 1.01–13.30), the type of vehicle involved is motorcycle (OR = 2.79; 95%CI: 1.25–6.24), bicycle (OR = 7.66; 95%CI: 2.70–21.68), having a head injury (OR = 4.50; 95%CI: 2.61–7.76) and hypothetical drunk driving (OR = 12.44; 95%CI: 2.01–76.87). CONCLUSIONS Relevant factors in healthcare costs were riding a motorcycle or bicycle, having a head injury, being under 18 years of age or 46 to 60 years of age and hypothetical drunk driving. It is important to implement prevention measures based on identified factors to reduce road accident rate and therefore, its socioeconomic costs.
  • Proposition and application of an environmental salubrity index in rural agglomerations Original Articles

    Braga, Débora de Lima; Bezerra, Nolan Ribeiro; Scalize, Paulo Sérgio

    Abstract in Portuguese:

    RESUMO OBJETIVO Propor um índice de salubridade ambiental que expresse as condições vividas em aglomerados rurais (ISARural), englobando indicadores e subindicadores para sua posterior aplicação em comunidades rurais do estado de Goiás. MÉTODOS A pesquisa foi desenvolvida em três fases: 1) análise prévia para proposição de um ISARural, contando com a participação de sete especialistas; 2) proposição do ISARuralpor meio do método Delphi, iniciando com 168 especialistas das 26 unidades federativas do Brasil e do Distrito Federal; e 3) aplicação do ISARuralem 43 comunidades rurais do estado de Goiás. RESULTADOS O ISARuralproposto resultou na composição de oito indicadores, sendo quatro relacionados ao saneamento básico, e os demais à saúde, às condições socioeconômicas, aos serviços públicos ofertados e às condições de moradia. O peso atribuído para cada indicador variou de 22,82%, para indicador de abastecimento de água, a 6,35%, para o indicador de serviços, podendo o ISARuralser aplicado na sua totalidade ou para avaliação de cada indicador individualmente. A aplicação do ISARuralem comunidades de Goiás evidenciou que 86% se classificam com baixa salubridade, destacando as piores condições para as comunidades quilombolas. Dentre os indicadores do ISARural, o de esgotamento sanitário foi caracterizado com a menor pontuação, o que demanda uma maior atenção do poder público. CONCLUSÕES Esse estudo cumpriu o papel de contribuir com a proposição de um índice em consonância com o conceito de salubridade ambiental, podendo ser empregado no âmbito das políticas públicas como um condicionante para a priorização das ações necessárias à melhoria das condições de salubridade identificadas. O ISARuralproposto pode ser aplicado na sua totalidade ou ainda na avaliação individual de cada indicador de sua composição. Os resultados da sua aplicação possibilitaram identificar as comunidades com piores condições de salubridade ambiental e os indicadores que requerem maior atenção prioritária nas comunidades estudadas.

    Abstract in English:

    ABSTRACT OBJECTIVE Propose an Índice de salubridade ambiental (ISARural – environmental salubrity index) that expresses the conditions experienced in rural agglomerations, including indicators and subindicators for its subsequent application in rural communities in the state of Goiás. METHODS We developed the research in three phases: 1) previous analysis for the proposition of an ISARural, with the participation of seven specialists; 2) proposition of the ISARural by means of the Delphi method, starting with 168 specialists from 26 federative units of Brazil and Distrito Federal; and 3) application of the ISARural in 43 rural communities in the state of Goiás. RESULTS The proposed ISARural resulted in the composition of eight indicators, four of which related to basic sanitation, and the others to health, socioeconomic conditions, public services offered, and housing conditions. The weight assigned to each indicator ranged from 22.82% for the water supply indicator to 6.35% for the service indicator, it is possible to apply the ISARural fully or to evaluate each indicator individually. The application of ISARural in communities of Goiás classified 86% of them with low salubrity, highlighting the worst conditions for quilombola communities. The sanitary sewage had the lowest score among the ISARural indicators, requiring greater attention from public authorities. CONCLUSIONS This study contributed to the proposition of an index in line with the concept of environmental salubrity, useful in the scope of public policies as a conditioner for the prioritization of actions needed to improve the salubrity conditions identified. The proposed ISARural can be fully applied or used in the individual evaluation of each indicator of its composition. The results of its application made it possible to identify the communities with the worst environmental salubrity conditions and the indicators that require greater priority attention in the communities studied.
  • Ambient air pollutants relate to hospital admissions for chronic obstructive pulmonary disease in Ganzhou, China Original Articles

    Zhou, Xingye; Li, Chenwei; Gao, Yanfang; Zhou, Chuanfei; Huang, Lei; Zhang, Xiaokang

    Abstract in English:

    ABSTRACT OBJECTIVE To evaluate the relationship between ambient air pollutants and chronic obstructive pulmonary disease in relatively low-polluted areas in China. METHODS Atmospheric pollutants levels and meteorological data were obtained from January 2016 to December 2020. The medical database including daily hospital admissions for chronic obstructive pulmonary disease (ICD10: J44) was derived from the First Affiliated Hospital of Gannan Medical University. The generalized additive model was used to analyze the percentage change with 95% confidence interval in daily hospital admissions for chronic obstructive pulmonary disease associated with a 10 µg/m3 increase in atmospheric pollutants levels. RESULTS In total, occurred 4,980 chronic obstructive pulmonary disease hospital admissions (not including emergency department visits) during 2016–2020. The mean concentrations of daily PM2.5, PM10, SO2, NO2, O3, and CO were 37.5 μg/m3, 60.1 μg/m3, 18.7 μg/m3, 23.5 μg/m3, 70.0 μg/m3, and 1.2 mg/m3 in Ganzhou. Each 10 µg/m3 increment of PM2.5, PM10, NO2, and O3 were significantly associated with 2.8% (95%CI: 1.0–4.7), 1.3% (95%CI: 0.3–2.4), 2.8% (95%CI: 0.4–5.4), and 1.5% (95%CI: 0.2–2.7) elevation in daily chronic obstructive pulmonary disease hospital admissions. The estimates of delayed effects of PM2.5, PM10, NO2, and O3 were observed at lag6, lag6, lag8, lag1, respectively. The health effects of particulate pollutants (PM2.5 and PM10) may be independent of other pollutants. The adverse effects of air pollutants were more evident in the warm season (May–Oct) than in the cold season (Nov–Apr). CONCLUSION Our study demonstrated that elevated concentrations of atmospheric pollutant (PM2.5, PM10, NO2, and O3), especially particulate pollutants, can be associated with increased daily count of hospital admissions for chronic obstructive pulmonary disease , which may promote further understanding of the potential hazards of relatively low levels of air pollution on chronic obstructive pulmonary disease and other respiratory disorders.
  • Attitudes of health professionals towards suicidal behavior: an intervention study Original Articles

    Faria, Jesiele Spindler; Marcon, Samira Reschetti; Nespollo, Alice Milani; Santos, Hugo Gedeon Barros dos; Espinosa, Mariano Martínez; Oliveira, Kleici Kleslly Brito de; Lima, Josemara Gomes da Silva

    Abstract in Portuguese:

    RESUMO OBJETIVO Avaliar o efeito de uma intervenção educativa sobre comportamento suicida nas atitudes dos profissionais de saúde da atenção primária. MÉTODO Ensaio clínico randomizado por conglomerados, com amostra de 261 profissionais de saúde, provenientes de 22 unidades de saúde selecionados por amostragem estratificada, elegidos e alocados aleatoriamente, mediante sorteio, em dois grupos: intervenção (n = 87) e controle (n = 174). Os participantes do grupo intervenção foram expostos a uma capacitação sobre comportamento suicida com duração de 20 horas. Todos os 261 participantes foram avaliados, antes e após a intervenção, e os grupos foram comparados para avaliar a atitude frente ao comportamento suicida utilizando o Suicide Behavior Attitude Questionnaire (SBAQ), avaliação feita por comparação das médias via teste t-Student para amostras independentes e Teste t pareado para amostras dependentes. RESULTADOS O grupo intervenção, na comparação intragrupos antes e depois da capacitação, bem como na comparação com o grupo controle, demonstrou diferenças estatisticamente significativas nas atitudes frente ao comportamento suicida, avaliadas a partir das diferenças de scores nos domínios: “percepção da capacidade profissional”, em todos os quatro itens; “sentimento negativo”, em seis dos sete itens; e no domínio “direito ao suicídio”, três dos cinco itens. CONCLUSÃO A capacitação breve desenvolvida na atenção primária à saúde foi efetiva para a melhora das atitudes dos participantes que integravam o grupo intervenção frente ao comportamento suicida.

    Abstract in English:

    ABSTRACT OBJECTIVE To evaluate the effect of an educational intervention on the attitudes of primary healthcare providers regarding patients with suicidal behavior. METHODS Clinical trial randomized by clusters, with a sample of 261 healthcare professionals, from 22 health units selected by stratified sampling, were chosen and randomly allocated, by drawing, into two groups: intervention (n = 87) and control (n = 174). The participants of the intervention group were exposed to a 20-hour training on suicidal behavior. All 261 participants were evaluated before and after the intervention; the groups were compared to evaluate their attitude towards suicidal behavior using the Suicide Behavior Attitude Questionnaire (SBAQ), an evaluation made by comparison of the means via t-Student test, for independent samples, and paired t-test, for dependent samples. RESULTS The intervention group, in comparison to their evaluation before and after training, as well as in the comparison with the evaluation of the control group, showed statistically significant differences in attitudes towards suicidal behavior, according to the differences presented in the scores for the domains: “perception of professional capacity,” in all four items; “negative feeling,” in six of the seven items; and in the “right to commit suicide” domain, in three of the five items. CONCLUSION The brief training developed in primary health care was effective to improve the attitudes of the participants who were part of the intervention group regarding patients with suicidal behavior.
  • Direct costs of prematurity and factors associated with birth and maternal conditions Original Articles

    Melo, Thamires Francelino Mendonça de; Carregaro, Rodrigo Luiz; Araújo, Wildo Navegantes de; Silva, Everton Nunes da; Toledo, Aline Martins de

    Abstract in Portuguese:

    RESUMO OBJETIVOS Estimar os custos diretos advindos com a assistência hospitalar a recém-nascidos prematuros extremos, moderados e tardios, sob a perspectiva de um hospital público em 2018. O segundo objetivo foi investigar se fatores associados ao nascimento e às condições maternas explicam os custos e o tempo de permanência hospitalar. MÉTODOS Estudo de custo da doença, com extração de dados a partir das autorizações de internação hospitalares e prontuários de um hospital público de grande porte do Distrito Federal. Estimou-se a associação de características dos recém-nascidos prematuros e das genitoras nos custos por meio de regressão linear com distribuição gamma. Na análise, adotou-se o cálculo dos parâmetros das estimativas (B), com intervalo de confiança de 95% (IC95%). Os parâmetros de incerteza foram estimados pelo intervalo de confiança de 95% e erro padrão por meio do método de Bootstrapping, com 1.000 amostragens. Realizou-se análise de sensibilidade determinística, considerando limites inferiores e superiores do IC95% na variação de cada componente de custo. RESULTADOS Foram incluídos 147 recém-nascidos prematuros. Verificamos um custo médio de R$ 1.120 para prematuros tardios, R$ 6.688 para prematuros moderados e R$ 17.395 para prematuros extremos. Verificamos também que os fatores associados ao custo foram idade gestacional (B = -123,00; IC95% -241,60 a -4,50); internação em UTI neonatal (B = 6.932,70; IC95% 5.309,40–8.556,00) e número de consultas pré-natal (B = -227,70; IC95% -403,30 a -52,00). CONCLUSÕES Verificamos um custo direto considerável advindo da assistência a recém-nascidos prematuros. A prematuridade extrema demonstrou um custo 15,5 vezes maior comparado à tardia. Verificamos ainda que uma maior quantidade de consultas pré-natal e a idade gestacional foram associadas a uma redução dos custos da prematuridade.

    Abstract in English:

    ABSTRACT OBJECTIVE To estimate the direct costs due to hospital care for extremely, moderate, and late preterm newborns, from the perspective of a public hospital in 2018. The second objective was to investigate whether factors associated with birth and maternal conditions explain the costs and length of hospital stay. METHODS This is a cost-of-illness study, with data extracted from hospital admission authorization forms and medical records of a large public hospital in the Federal District, Brazil. The association of characteristics of preterm newborns and mothers with costs was estimated by linear regression with gamma distribution. In the analysis, the calculation of the parameters of the estimates (B), with a confidence interval of 95% (95%CI), was adopted. The uncertainty parameters were estimated by the 95% confidence interval and standard error using the Bootstrapping method, with 1,000 samples. Deterministic sensitivity analysis was performed, considering lower and upper limits of 95%CI in the variation of each cost component. RESULTS A total of 147 preterm newborns were included. We verified an average cost of BRL 1,120 for late preterm infants, BRL 6,688 for moderate preterm infants, and BRL 17,395 for extremely preterm infants. We also observed that factors associated with the cost were gestational age (B = -123.00; 95%CI: -241.60 to -4.50); hospitalization in neonatal ICU (B = 6,932.70; 95%CI: 5,309.40–8,556.00), and number of prenatal consultations (B = -227.70; 95%CI: -403.30 to -52.00). CONCLUSIONS We found a considerable direct cost resulting from the care of preterm newborns. Extreme prematurity showed a cost 15.5 times higher than late prematurity. We also verified that a greater number of prenatal consultations and gestational age were associated with a reduction in the costs of prematurity.
  • Mortality from chronic respiratory disease in Brazil: time trend and forecasts Original Articles

    Oliveira, Marcio Sacramento de; Montovani, Elisa Hypólito; Santana, Maria de Fátima Ebole de; Ponce de Leon, Antonio Carlos Monteiro; Marques, Márcio Candeias

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar a tendência temporal das taxas mensais de mortalidade por doenças respiratórias crônicas no Brasil de 1996 até 2017, com projeções para 2022, além de analisar a possibilidade de cumprimento da meta do Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas Não Transmissíveis no Brasil de 2011 até 2022. MÉTODOS Trata-se de estudo ecológico que utiliza dados do Sistema de Informações sobre Mortalidade, do Sistema de Informações Demográficas e Socioeconômicas e da Pesquisa Nacional por Amostra de Domicílios Contínua. O recorte etário foi estabelecido entre 30 e 69 anos e a evolução das taxas no tempo foi feita por meio de modelos autorregressivos integrados de média móvel em plataforma estatística R. RESULTADOS As taxas de mortalidade precoce por doenças respiratórias crônicas apresentam-se decrescentes no Brasil como um todo e na maior parte das capitais, assim como, há tendência a atingir a meta do Ministério da Saúde na maior parte do país. Para capitais que tendem a não atingir a meta, verifica-se associação entre mortalidade e indicadores sociais, rede assistencial de saúde e frequência do tabagismo. CONCLUSÃO Pretende-se que o estudo possibilite um melhor planejamento do sistema público de saúde para o controle das doenças respiratórias crônicas.

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze the time trend of monthly mortality rates from chronic respiratory diseases in Brazil from 1996 to 2017, with forecasts for 2022, besides analyzing the possibility of achieving the goal of the Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas Não Transmissíveis no Brasil (Strategic Action Plan to Tackle Chronic Noncommunicable Diseases in Brazil) from 2011 to 2022. METHODS This is an ecological study that uses data from Sistema de Informações sobre Mortalidade (SIM – Mortality Information System), Sistema de Informações Demográficas e Socioeconômicas (Demographic and Socioeconomic Information System) and Pesquisa Nacional por Amostra de Domicílios Contínua (PNAD Contínua – Continuous National Household Sample Survey). We established the age range between 30 and 69 years old and the evolution of the rates over time was made by autoregressive integrated moving average models in R statistical tool. RESULTS Premature mortality rates from chronic respiratory diseases are decreasing in Brazil as a whole, mostly in state capitals. There is also a trend to reach the Ministry of Health’s goal in most of the country. For capitals that tend not to reach the goal, there is an association between mortality and social indicators, healthcare network and frequency of smoking. CONCLUSION This study intends to improve planning of the public health system for the control of chronic respiratory diseases.
  • Hospitalizations from covid-19: a health planning tool Original Articles

    Santolino, Miguel; Alcañiz, Manuela; Bolancé, Catalina

    Abstract in Spanish:

    RESUMEN OBJETIVO Predecir el número futuro de hospitalizaciones por covid-19 a partir del número de casos positivos diagnosticados. MÉTODO Usando datos del Panel covid-19 registrados en España en la Red Nacional de Vigilancia Epidemiológica (Renave), se ajusta un modelo de regresión con estructura multiplicativa para explicar y predecir el número de hospitalizaciones a partir de la serie retardada de casos positivos diagnosticados durante el periodo entre el 11 de mayo de 2020 y el 20 de septiembre de 2021. Se analiza el efecto sobre el número de hospitalizaciones del tiempo transcurrido desde el inicio del programa de vacunación. RESULTADOS El número de retardos de la serie de casos positivos que mayor capacidad explicativa tiene sobre el número de hospitalizaciones es de nueve días. La variabilidad del número de hospitalizaciones explicada por el modelo es elevada (R2 ajustado: 96,6%). Antes del inicio del programa de vacunación, el número esperado de ingresos hospitalarios en el día t era igual al 20,2% de los casos positivos del día t-9 elevado a 0,906. Iniciado el programa de vacunación, este porcentaje se redujo un 0,3% diario. Con el mismo modelo se obtiene que en la primera ola de la pandemia el número de casos positivos fue más de seis veces el que figura en los registros oficiales. CONCLUSIONES Partiendo de los casos de covid-19 detectados hasta una fecha, el modelo propuesto permite estimar el número de hospitalizaciones con nueve días de antelación. Ello lo convierte en una herramienta útil para prever con cierta anticipación la presión hospitalaria que el sistema sanitario tendrá que soportar como consecuencia de la enfermedad.

    Abstract in English:

    ABSTRACT OBJECTIVE Estimate the future number of hospitalizations from Covid-19 based on the number of diagnosed positive cases. METHOD Using the covid-19 Panel data recorded in Spain at the Red Nacional de Vigilancia Epidemiológica, Renave (Epidemiological Surveillance Network), a regression model with multiplicative structure is adjusted to explain and predict the number of hospitalizations from the lagged series of positive cases diagnosed from May 11, 2020 to September 20, 2021. The effect of the time elapsed since the vaccination program starting on the number of hospitalizations is reviewed. RESULTS Nine days is the number of lags in the positive cases series with greatest explanatory power on the number of hospitalizations. The variability of the number of hospitalizations explained by the model is high (adjusted R2: 96.6%). Before the vaccination program starting, the expected number of hospitalizations on day t was 20.2% of the positive cases on day t-9 raised to 0.906. After the vaccination program started, this percentage was reduced by 0.3% a day. Using the same model, we find that in the first pandemic wave the number of positive cases was more than six times that reported on official records. CONCLUSIONS Starting from the covid-19 cases detected up to a given date, the proposed model allows estimating the number of hospitalizations nine days in advance. Thus, it is a useful tool for forecasting the hospital pressure that health systems shall bear as a consequence of the disease.
  • Performance evaluation of tuberculosis control in Brazilian municipalities Original Articles

    Pinto, Priscila Fernanda Porto Scaff; Santos, Beatriz Pinheiro Schindler dos; Teixeira, Camila Silveira Silva; Nery, Joilda Silva; Amorim, Leila Denise Alves Ferreira; Sanchez, Mauro Niskier; Barreto, Mauricio Lima; Pescarini, Julia Moreira

    Abstract in Portuguese:

    RESUMO OBJETIVO Avaliar o desempenho no controle da tuberculose dos municípios brasileiros. MÉTODOS Estudo ecológico com municípios brasileiros que notificaram pelo menos quatro casos novos de tuberculose, com no mínimo um caso novo de tuberculose pulmonar entre 2015 e 2018. Os municípios foram estratificados de acordo com a população em < 50 mil, 50–100 mil, 100–300 mil e > 300 mil habitantes e foi utilizado o método k-médias para agrupá-los dentro de cada faixa populacional segundo desempenho de seis indicadores da doença. RESULTADOS Foram incluídos 2.845 municípios brasileiros abrangendo 98,5% (208.007/211.174) dos casos novos de tuberculose do período. Para cada faixa populacional identificou-se três grupos (A, B e C) de municípios segundo desempenho dos indicadores: A os mais satisfatórios, B os intermediários e C os menos satisfatórios. Municípios do grupo A com < 100 mil habitantes apresentaram resultados acima das metas para confirmação laboratorial (≥ 72%), abandono (≤ 5%) e cura (≥ 90%), e abrangeram 2% dos casos novos da doença. Por outro lado, os municípios dos grupos B e C apresentaram pelo menos cinco indicadores com resultados abaixo das metas – testagem HIV (< 100%), exame de contatos (< 90%), tratamento diretamente observado (< 90%), abandono (> 5%) e cura (< 90%) –, e corresponderam a 66,7% dos casos novos de tuberculose. Já no grupo C dos municípios com > 300 mil habitantes, que incluiu 19 das 27 capitais e 43,1% dos casos novos de tuberculose, encontrou-se os menores percentuais de exames de contatos (média = 56,4%) e tratamento diretamente observado (média = 15,4%), elevado abandono (média = 13,9%) e baixa cobertura da atenção básica (média = 66,0%). CONCLUSÕES Grande parte dos casos novos de tuberculose ocorreu em municípios com desempenho insatisfatório para o controle da doença, onde expandir a cobertura da atenção básica pode reduzir o abandono e elevar o exame de contatos e tratamento diretamente observado.

    Abstract in English:

    ABSTRACT OBJECTIVE To evaluate the performance of tuberculosis control in Brazilian municipalities. METHODS This is an ecological study on Brazilian municipalities that notified at least four new cases of tuberculosis, with a minimum of one new case of pulmonary tuberculosis between 2015 and 2018. The municipalities were stratified according to the population in < 50 thousand, 50–100 thousand, 100–300 thousand, and > 300 thousand inhabitants, and the k-means method was used to group them within each population range according to the performance of six indicators of the disease. RESULTS A total of 2,845 Brazilian municipalities were included, comprising 98.5% (208,007/211,174) of new tuberculosis cases in the period. For each population range, three groups (A, B, and C) of municipalities were identified according to the performance of the indicators: A, the most satisfactory; B, the intermediates; and C, the least satisfactory. Municipalities in group A with < 100 thousand inhabitants presented results above the targets for laboratory confirmation (≥ 72%), abandonment (≤ 5%), and cure (≥ 90%), and comprised 2% of new cases of the disease. Conversely, municipalities of groups B and C presented at least five indicators with results below the targets – HIV testing (< 100%), contact investigation (< 90%), directly observed therapy (< 90%), abandonment (> 5%), and cure (< 90%) –, and corresponded to 66.7% of new cases of tuberculosis. In group C of municipalities with > 300 thousand inhabitants, which included 19 of the 27 capitals and 43.1% of new cases of tuberculosis, the lowest percentages of contact investigation (mean = 56.4%) and directly observed therapy (mean = 15.4%) were verified, in addition to high abandonment (mean = 13.9%) and low coverage of primary health care (mean = 66.0%). CONCLUSIONS Most new cases of tuberculosis occurred in municipalities with unsatisfactory performance for disease control. Expanding the coverage of primary health care in these places can reduce abandonment and increase the contact investigation and directly observed therapy.
  • Measles resurgence in Brazil: analysis of the 2019 epidemic in the state of São Paulo Original Articles

    Makarenko, Cristina; San Pedro, Alexandre; Paiva, Natalia Santana; Santos, Jefferson Pereira Caldas dos; Medronho, Roberto de Andrade; Gibson, Gerusa

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar o perfil epidemiológico dos casos e o padrão de difusão espacial da maior epidemia de sarampo do Brasil ocorrida no período pós-eliminação, no estado de São Paulo. MÉTODO Estudo transversal, baseado em casos confirmados de sarampo em 2019. Foi conduzida análise bivariada das variáveis socioeconômicas, clínicas e epidemiológicas, segundo vacinação prévia e ocorrência de hospitalização, combinada a uma análise de difusão espacial dos casos por meio da metodologia de interpolação pela ponderação do inverso da distância. RESULTADOS Dos 15.598 casos confirmados, 2.039 foram hospitalizados e 17 evoluíram para o óbito. O pico epidêmico ocorreu na semana epidemiológica 33, após a confirmação do primeiro caso, na semana epidemiológica 6. A maioria dos casos era homem (52,1%), com idade entre 18 e 29 anos (38,7%), identificados como brancos (70%). Adultos jovens (39,7%) e menores de cinco anos (32,8%) foram as faixas etárias mais acometidas. Observou-se maior proporção de vacinação prévia em brancos, quando comparados a pretos, pardos, amarelos e indígenas (p < 0,001), assim como no grupo mais escolarizado, quando comparado às demais categorias (p < 0,001). O risco de hospitalização foi maior em crianças, quando comparado à faixa etária mais idosa (RI = 2,19; IC95% 1,66–2,88), assim como entre não vacinados, quando comparado a vacinados (RI = 1,59; IC95% 1,45–1,75). O padrão de difusão por contiguidade combinado à difusão por realocação seguiu a hierarquia urbana das regiões de influência das principais cidades. CONCLUSÃO Além da vacinação de rotina em crianças, os achados indicam a necessidade de campanhas de imunização de adultos jovens. Adicionalmente, estudos que busquem investigar a ocorrência de clusters de populações vulneráveis, propensas a menor cobertura de vacinação, são essenciais para ampliar a compreensão sobre a dinâmica de transmissão da doença e, assim, reorientar estratégias de controle que garantam a eliminação da doença.

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze the epidemiological profile of cases and the pattern of spatial diffusion of the largest measles epidemic in Brazil that occurred in the post-elimination period in the state of São Paulo. METHOD A cross-sectional study based on confirmed measles cases in 2019. Bivariate analysis was performed for socioeconomic, clinical, and epidemiological variables, according to prior vaccination and hospitalization, combined with an analysis of spatial diffusion of cases using the Inverse Distance Weighting (IDW) method. RESULTS Of the 15,598 confirmed cases, 2,039 were hospitalized and 17 progressed to death. The epidemic peak occurred in epidemiological week 33, after confirmation of the first case, in the epidemiological week 6. Most cases were male (52.1%), aged between 18 and 29 years (38.7%), identified as whites (70%). Young adults (39.7%) and children under five years (32.8%) were the most affected age groups. A higher proportion of previous vaccination was observed in whites as compared to Blacks, browns, yellows and indigenous people (p < 0.001), as well as in the most educated group compared to the other categories (p < 0.001). The risk of hospitalization was higher in children than in the older age group (RI = 2.19; 95%CI: 1.66–2.88), as well as in the unvaccinated than in the vaccinated (RI = 1.59; 95%CI: 1.45–1.75). The pattern of diffusion by contiguity combined with diffusion by relocation followed the urban hierarchy of the main cities’ regions of influence. CONCLUSION In addition to routine vaccination in children, the findings indicate the need for immunization campaigns for young adults. In addition, studies that seek to investigate the occurrence of clusters of vulnerable populations, prone to lower vaccination coverage, are essential to broaden the understanding of the dynamics of transmission and, thus, reorienting control strategies that ensure disease elimination.
  • Workaholism and burnout among stricto sensu graduate professors Original Articles

    Barreto, Maynara Fernanda Carvalho; Galdino, Maria José Quina; Fernandes, Frederico Garcia; Martins, Júlia Trevisan; Marziale, Maria Helene Palucci; Haddad, Maria do Carmo Fernandez Lourenço

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar a associação entre trabalho excessivo e trabalho compulsivo com as dimensões da síndrome de burnout em docentes de mestrado e doutorado em Letras e Linguística do Brasil. MÉTODOS Estudo transversal realizado com 585 docentes permanentes de pós-graduação stricto sensu em Letras e Linguística do Brasil. A obtenção dos dados ocorreu entre fevereiro e agosto de 2019, por meio de um questionário online. Os desfechos deste estudo foram as dimensões trabalho compulsivo e trabalho excessivo da escala Dutch Work Addiction Scale, as dimensões da Maslach Burnout Inventory TM e seus fatores associados, identificados por modelos múltiplos de regressão logística. RESULTADOS Docentes com alto nível de trabalho excessivo (29,40%) apresentaram 2,75 vezes a chance de exaustão emocional alta e 2,08 vezes a chance de despersonalização alta. Quanto aos docentes com alto nível de trabalho compulsivo (8,03%), apresentaram 4,88 vezes a chance de exaustão emocional alta e 2,97 vezes a chance de despersonalização alta. Não foi identificado associação entre trabalho excessivo e trabalho compulsivo com a baixa realização profissional. CONCLUSÃO Os resultados mostraram que existe uma associação estatisticamente significativa entre trabalho excessivo e trabalho compulsivo com exaustão emocional alta e despersonalização alta, possibilitando aos gestores e docentes refletirem os critérios que norteiam seus processos laborais, a fim de adotarem modelos de gestão, políticas reguladoras institucionais e estratégias adequadas para melhorar as condições de trabalho e saúde dos docentes.

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze the association of excessive work and compulsive work with the dimensions of the burnout syndrome in masters and doctoral professors of Languages, Literature, and Linguistics in Brazil. METHODS Cross-sectional study carried out with 585 permanent professors of stricto sensu graduate studies in Languages, Literature, and Linguistics in Brazil. Data collection took place between February and August 2019, by an online questionnaire. The outcomes of this study were the compulsive work and excessive work dimensions of the Dutch Work Addiction Scale, the Maslach Burnout Inventory TM dimensions and their associated factors, identified by multiple logistic regression models. RESULTS Professors with a high level of excessive work (29.40%) had 2.75 times the chance of high emotional exhaustion and 2.08 times the chance of high depersonalization. Regarding professors with a high level of compulsive work (8.03%), they had 4.88 times the chance of high emotional exhaustion and 2.97 times the chance of high depersonalization. No association of excessive work and compulsive work with low professional fulfillment was identified. CONCLUSION The results showed a statistically significant association of excessive work and compulsive work with high emotional exhaustion and high depersonalization, allowing managers and professors to reflect the criteria that guide their work processes, to adopt management models, institutional regulatory policies, and strategies to improve the working conditions and health of professors.
  • Impact of covid-19 on people living with HIV-1: care and prevention indicators at a local and nationwide level, Santo André, Brazil Comments

    Matsuda, Elaine Monteiro; Oliveira, Isabela Penteriche de; Bao, Laura Ballesteros; Manzoni, Fernanda Matsuda; Campos, Norberto Camilo; Varejão, Beatriz Brajal; Leal, Maristelly Pereira; Nascimento, Vania Barbosa; Brígido, Luís Fernando de Macedo

    Abstract in English:

    ABSTRACT The world has been dealing with Aids for forty years, covid-19 accentuated societal inequalities and promoted a rupture in care and prevention, including for people living with HIV. We compiled official HIV indicators, analyzed the impact of covid-19 in Brazil, at São Paulo State (SP), and compared it to the municipality of Santo André (in the state of São Paulo), which adopted linkage/retention strategies to mitigate the impact of covid-19. From 2019 to 2020, suppression/adhesion rates remained stable. The number of new treatments decreased both in Brazil (-19.75%) and São Paulo (-16.44%), but not in Santo André, where 80% of new patients started treatment within 30 days from their first TCD4 test (70% in São Paulo and 64% in Brazil). However, PrEP dispensing increased during this period. The distribution of 2,820 HIV self-tests in Santo André lead to only one documented new HIV diagnosis linked to care. Synergistic strategies to swiftly diagnose and connect new cases, ensuring retention as well as rescuing missing patients deserve priority in the fight against HIV, especially in times of covid-19.
  • Sponsorship by food and beverage companies in soccer: an analysis of the 2019 Copa América Original Articles

    Araujo, Larissa Cardoso de Miranda; Matos, Juliana de Paula; Horta, Paula Martins

    Abstract in Portuguese:

    RESUMO OBJETIVO Identificar o patrocínio por empresas do setor de alimentos e bebidas das seleções participantes da Copa América de Futebol 2019 e associar esse patrocínio a características das seleções e de seus respectivos países. MÉTODOS Foram identificados os patrocinadores das 10 seleções participantes da 46ª edição da Copa América de Futebol. Essas entidades foram classificadas em empresas i) de alimentos, ii) de bebidas alcoólicas e iii) de outros segmentos. As empresas de alimentos foram classificadas de acordo com seus produtos, segundo a classificação NOVA. Além disso, dados sobre o número de títulos anteriormente conquistados pelas seleções na Copa América e na Copa do Mundo foram obtidos, assim como dados do índice de desenvolvimento humano, de venda anual per capita de alimentos ultraprocessados e de consumo anual per capita de bebidas alcoólicas dos países. RESULTADOS Um total de 89 patrocínios foram identificados para as 10 seleções estudadas, alguns desses apoiando duas ou mais equipes. Dezoito por cento dos patrocinadores eram empresas de alimentos, sendo 12,4% de alimentos ultraprocessados. A categoria de bebidas alcoólicas representou 7,9% dos patrocinadores. As empresas de bebidas ultraprocessadas e as de bebidas alcoólicas patrocinaram sete das 10 seleções estudadas. Notou-se maior participação de patrocinadores de empresas de alimentos ultraprocessados em seleções de países com maior índice de desenvolvimento humano, venda de alimentos ultraprocessados e número de títulos de Copa América e Copa do Mundo. Já o patrocínio por empresas de bebidas alcoólicas foi maior em seleções de países com menor índice de desenvolvimento humano, consumo de álcool e número de títulos em Copa América e Copa do Mundo. CONCLUSÃO Evidenciou-se uma presença significativa de empresas de alimentos ultraprocessados e de bebidas alcoólicas como patrocinadores das seleções sul-americanas de futebol e que as características de desempenho esportivo das seleções e questões socioeconômicas e de mercado dos países se associam à ocorrência do patrocínio.

    Abstract in English:

    ABSTRACT OBJECTIVE To identify the sponsorship by food and beverage companies of the teams participating in the 2019 Copa América Soccer Cup and associate this sponsorship with characteristics of the teams and their respective countries. METHODS The sponsors of the 10 teams participating in the 46th edition of the Copa América were identified. These entities were classified into (i) food companies, (ii) alcoholic beverage companies, and (iii) other segments. The food companies were classified according to their products, according to the NOVA classification. In addition, data on the number of titles previously won by the teams in the Copa America and the World Cup were obtained, as well as data on the countries’ Human Development Index, annual per capita sales of ultra-processed foods, and annual per capita consumption of alcoholic beverages. RESULTS A total of 89 sponsorships were identified for the 10 teams studied, some of these supporting two or more teams. Eighteen percent of the sponsors were food companies, with 12.4% being ultra-processed foods. The alcoholic beverage category represented 7.9% of the sponsors. Ultra-processed beverage and alcoholic beverage companies sponsored seven of the 10 teams studied. We noted higher participation of ultra-processed foods company sponsors in teams from countries with higher Human Development Index, sales of ultra-processed foods, and number of Copa América and World Cup titles. The sponsorship by alcoholic beverage companies was higher for teams from countries with lower Human Development Index, alcohol consumption, and number of Copa América and World Cup titles. CONCLUSION A significant presence of ultra-processed food and alcoholic beverage companies as sponsors of South American soccer teams was noted, along with the fact that sport performance characteristics of the teams and socioeconomic and market issues of the countries are associated with the occurrence of sponsorship.
  • Microcephaly measurement in adults and its association with clinical variables Original Articles

    Costa, Nicole Rezende da; Mancine, Livia; Salvini, Rogerio; Teixeira, Juliana de Melo; Rodriguez, Roberta Diehl; Leite, Renata Elaine Paraizo; Nascimento, Camila; Pasqualucci, Carlos Augusto; Nitrini, Ricardo; Jacob-Filho, Wilson; Lafer, Beny; Grinberg, Lea Tenenholz; Suemoto, Claudia Kimie; Nunes, Paula Villela

    Abstract in English:

    ABSTRACT OBJECTIVE To establish a microcephaly cut-off size in adults using head circumference as an indirect measure of brain size, as well as to explore factors associated with microcephaly via data mining. METHODS In autopsy studies, head circumference was measured with an inelastic tape placed around the skull. Total brain volume was also directly measured. A linear regression was used to determine the association of head circumference with brain volume and clinical variables. Microcephaly was defined as head circumference that were two standard deviations below the mean of significant clinical variables. We further applied an association rule mining to find rules associating microcephaly with several sociodemographic and clinical variables. RESULTS In our sample of 2,508 adults, the mean head circumference was 55.3 ± 2.7cm. Head circumference was related to height, cerebral volume, and sex (p < 0.001 for all). Microcephaly was present in 4.7% of the sample (n = 119). Out of 34,355 association rules, we found significant relationships between microcephaly and a clinical dementia rating (CDR) > 0.5 with an informant questionnaire on cognitive decline in the elderly (IQCODE) ≥ 3.4 (confidence: 100% and lift: 5.6), between microcephaly and a CDR > 0.5 with age over 70 years (confidence: 42% and lift: 2.4), and microcephaly and males (confidence: 68.1% and lift: 1.3). CONCLUSION Head circumference was related to cerebral volume. Due to its low cost and easy use, head circumference can be used as a screening test for microcephaly, adjusting it for gender and height. Microcephaly was associated with dementia at old age.
  • Tuberculosis, vulnerabilities, and HIV in homeless persons: a systematic review Review

    Gioseffi, Janaína Rosenburg; Batista, Ramaiene; Brignol, Sandra Mara

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar, sistematizar e compilar os fatores de vulnerabilidade (social, individual e programática) associados à tuberculose e HIV em pessoas em situação de rua. MÉTODOS Revisão sistemática de literatura de publicações quantitativas sobre tuberculose em pessoas em situação de rua entre os anos de 2014 e 2020, seguindo o guia de recomendações PRISMA e, para análise de viés, a ferramenta Joanna Briggs Institute Critical Appraisal. Agrupou-se as publicações segundo as vulnerabilidades. RESULTADOS Entre 372 publicações encontradas, selecionaram-se 16 segundo os critérios de elegibilidade. Em 10 estudos, foi descrita ocorrência de tuberculose e HIV. Os fatores de vulnerabilidade individual, social e programática mais descritas foram uso de drogas, coinfecção com HIV e falha no tratamento da tuberculose, respectivamente. A média de tempo em situação de rua também se mostrou relacionada à maior frequência de tuberculose e da infecção latente da tuberculose segundo literatura. CONCLUSÃO O estigma e a desumanização associados às pessoas em situação de rua foram descritos em todos os estudos revisados, sendo importantes barreiras no acesso aos serviços de saúde. A vivência na rua potencializa os riscos para a ocorrência de doenças crônicas e infecciosas, bem como a priorização de questões mais pragmáticas à manutenção da vida, como segurança e alimentação, em detrimento à saúde. Os resultados encontrados podem ser utilizados para embasar hipóteses para futuras pesquisas e para reforçar e direcionar políticas públicas de saúde e sociais já existentes para o enfrentamento da tuberculose e HIV na pessoa em situação de rua.

    Abstract in English:

    ABSTRACT OBJECTIVE Analyze, systematize, and compile social, individual, and programmatic vulnerability factors associated with tuberculosis and HIV in homeless persons. METHODS This is a systematic literature review assessing quantitative studies, published between 2014 and 2020, on the prevalence of tuberculosis in homeless persons. Our review grouped studies according to vulnerabilities, followed the PRISMA recommendation guide, and used the Joanna Briggs Institute Critical Appraisal tool for bias analysis. RESULTS Of the 372 publications found, 16 were selected according to our eligibility criteria. In total, 10 studies assessed tuberculosis and HIV. The most commonly described factors for individual, social, and programmatic vulnerability were drug use, HIV coinfection, and tuberculosis treatment failure, respectively. The literature also claims that average homelessness length related to a higher frequency of tuberculosis and latent tuberculosis infection. CONCLUSION All reviewed studies described how homeless persons suffer with stigma and dehumanization, which are important barriers to their access to health services. Homelessness enhances the risks of chronic and infectious diseases and prioritizes issues which are more pragmatic for the maintenance of life, such as safety and food, to the detriment of health. The results can be used to support hypotheses for future research and to reinforce and direct existing public health and social policies to cope with tuberculosis and HIV in homeless persons.
  • ArboAlvo: stratification method for territorial receptivity to urban arboviruses Original Articles

    Siqueira, Alexandre San Pedro; Praça, Heitor Levy Ferreira; Santos, Jefferson Pereira Caldas dos; Albuquerque, Hermano Gomes; Pereira, Leandro Vouga; Simões, Taynãna Cesar; Gusmão, Eduardo Viana Vieira; Pereira, Aline Aparecida Thomaz; Pimenta Júnior, Fabiano Geraldo; Nobre, Aline Araújo; Alves, Mariane Branco; Barcellos, Christovam; Carvalho, Marilia Sá; Sabroza, Paulo Chagastelles; Honório, Nildimar Alves

    Abstract in Portuguese:

    RESUMO OBJETIVO Apresentar a metodologia de estratificação das arboviroses urbanas (dengue, zika e chikungunya) pelo índice de receptividade territorial, instrumento de vigilância e controle dessas doenças que considera a heterogeneidade territorial intramunicipal. MÉTODOS Estudo ecológico que utiliza como unidade de análise as áreas de abrangência dos centros de saúde de Belo Horizonte (MG). Para a construção do índice de receptividade territorial foram selecionados indicadores de determinação socioambiental das arboviroses urbanas a fim de integrar à análise de componentes principais. As componentes resultantes foram ponderadas por análise de processos hierárquicos e agregadas por meio de álgebra de mapas. RESULTADOS O índice de receptividade territorial evidenciou grande heterogeneidade das condições de infraestrutura urbana. As áreas classificadas como alta e muito alta receptividade correspondem a aproximadamente 33% da área ocupada e se concentram sobretudo nas regiões de planejamento administrativo Leste, Nordeste, Norte, Oeste e Barreiro, principalmente em áreas limítrofes do município. Quando sobrepostas à densidade de casos de dengue e de ovos de Aedes em 2016, a estratificação pelo índice de receptividade territorial às arboviroses urbanas demonstra que áreas de muito alta receptividade apresentam uma densidade de casos, bem como de ovos de Aedes superior àquela observada nas demais áreas da cidade, o que corresponde a um percentual bastante reduzido do território municipal (13,5%). CONCLUSÕES As análises indicam a necessidade do desenvolvimento de ações de vigilância e controle adequadas para cada contexto, superando, assim, a lógica de alocação homogênea em todo o território.

    Abstract in English:

    ABSTRACT OBJECTIVE To present the urban arboviruses (dengue, zika and chikungunya) stratification methodology by the territorial receptivity Index, an instrument for the surveillance and control of these diseases, which considers the heterogeneity of an intra-municipal territory. METHODS Ecological study that uses as unit of analysis the areas covered by health centers in Belo Horizonte. For the development of a territorial receptivity index, indicators of socio-environmental determination of urban arboviruses were selected in order to integrate the analysis of main components. The resulting components were weighted by the analytic hierarchy process and combined via map algebra. RESULTS The territorial receptivity index showed great heterogeneity of urban infrastructure conditions. The areas classified with high and very high receptivity correspond to approximately 33% of the occupied area and are mainly concentrated in the administrative planning regions of East, Northeast, North, West, and Barreiro, especially in areas surrounding the municipality. When the density of dengue cases and Aedes eggs, from 2016, were superimposed with the stratification by the index of territorial receptivity to urban arboviruses, areas of very high receptivity had a high density of cases and Aedes eggs – higher than that observed in other areas of the city, which corresponds to a very small percentage of the municipal territory (13.5%). CONCLUSION The analyses indicate the need for the development of adequate surveillance and control actions for each context, overcoming the logic of homogeneous allocation throughout the territory.
  • Trend in physical activity patterns of pregnant women living in Brazilian capitals Original Articles

    Rinaldi, Ana Elisa Madalena; Paula, Janaína Aparecida de; Almeida, Maiara Aparecida Miálich; Corrente, José Eduardo; Carvalhaes, Maria Antonieta Barros Leite

    Abstract in Portuguese:

    RESUMO OBJETIVOS Descrever a tendência da atividade física (AF) em quatro domínios realizada por gestantes residentes nas capitais brasileiras e no Distrito Federal (DF) e verificar a associação entre fatores sociodemográficos e a prática de atividade física de lazer entre 2007 e 2017. MÉTODOS Estudo de tendência temporal realizado com dados do Sistema de Vigilância de Fatores de Risco para doenças crônicas por inquérito telefônico (Vigitel). Foram estudadas 3.730 gestantes no período, considerando as variáveis sociodemográficas (idade, macrorregião, trabalho, estado civil, escolaridade, cor) e de atividade física nos quatro domínios (lazer, trabalho, deslocamento, doméstico – sim/não). Para as gestantes que realizavam atividade física de lazer, foi questionada a duração, expressa na variável AF ≥ 150 minutos/semana (sim/não). A tendência temporal foi avaliada por regressão linear ponderada pela variância (variação anual média foi expressa em pontos percentuais – p.p.) e a associação de fatores sociodemográficos com a atividade física de lazer por regressão de Poisson, com estimativa da razão de prevalência (RP). RESULTADOS A prevalência de gestantes com 12 anos ou mais de estudo aumentou no período analisado (+1,37 p.p./ano), assim como a prevalência de gestantes com mais de 35 anos (+1,11 p.p./ano) e aquelas que trabalham (+0,75 p.p./ano). A prevalência de atividade física de lazer pelas gestantes aumentou de 29,3%, em 2007, para 37,6%, em 2017 (+1,37 p.p./ano), e de AF ≥ 150min/semana de 2,3% para 20,6% (+2,33 p.p./ano), respectivamente, e houve redução de atividades físicas domésticas de 63,9% para 38,9% (-1,65 p.p./ano). A prevalência da prática de atividade física de lazer foi superior entre as gestantes com mais de 12 anos de estudo (RP = 2,22; IC95% 1,73–2,84), quando comparadas àquelas com menos de 8 anos, e menor entre gestantes pretas/pardas/indígenas, comparadas às brancas/amarelas (RP = 0,87; IC95% 0,78–0,97). A prevalência da AF ≥ 150min/semana aumentou conforme os anos de escolaridade e idade. CONCLUSÕES A prevalência da prática de atividade física de lazer e sua realização por ≥ 150minutos/semana aumentou no período analisado, e ambas se associaram diretamente à maior escolaridade.

    Abstract in English:

    ABSTRACT OBJECTIVES To describe the trend of physical activity (PhA) in four domains performed by pregnant women living in Brazilian capitals and the Federal District (FD) and to verify the association between sociodemographic factors and the practice of leisure-time physical activity between 2007 and 2017. METHODS Time trend study carried out with data from the Surveillance System of Risk Factors for chronic diseases by telephone survey (Vigitel). A total of 3,730 pregnant women were interviewed in the period, considering sociodemographic variables (age, macro-region, work, marital status, schooling, skin color) and physical activity in the four domains (leisure-time, work, commuting, domestic – yes/no). For pregnant women who performed leisure-time physical activity, its duration was inquired, expressed in the variable PhA ≥ 150 minutes/week (yes/no). The time trend was evaluated by variance-weighted linear regression (average annual variation was expressed in percentage points – pp) and the association of sociodemographic factors with leisure-time physical activity by Poisson regression, with prevalence ratio (PR) estimation. RESULTS The prevalence of pregnant women with 12 years of schooling or more increased in the analyzed period (+1.37 pp/year), as well as the prevalence of pregnant women with more than 35 years of age (+1.11 pp/year) and those who work (+0.75 pp/year). The prevalence of leisure-time physical activity by pregnant women increased from 29.3% in 2007 to 37.6% in 2017 (+1.37 pp/year), and of PhA ≥ 150min/week from 2.3% to 20.6% (+2.33 pp/year), respectively, and there was a reduction in domestic physical activities from 63.9% to 38.9% (-1.65 pp/year). The prevalence of leisure-time physical activity was higher among pregnant women with more than 12 years of schooling (PR = 2.22; 95%CI: 1.73–2.84) as compared to those with less than 8 years of age, and lower among black/brown/indigenous pregnant women, compared to white/yellow ones (PR = 0.87; 95%CI: 0.78–0.97). The prevalence of PhA ≥ 150min/week increased according to years of schooling and age. CONCLUSIONS The prevalence of leisure-time physical activity and its performance for ≥ 150 minutes/week increased in the analyzed period, and both were directly associated with greater schooling.
  • Determinants of late neonatal nosocomial infection: a case-control study in Ceará Original Articles

    Lima, Carmen Sulinete Suliano da Costa; Rocha, Hermano Alexandre Lima; Araújo, David Augusto Batista Sá; Silva, Cláudia

    Abstract in Portuguese:

    RESUMO OBJETIVO Identificar os fatores determinantes para infecções relacionadas à assistência à saúde (IRAS) tardias em terapia intensiva neonatal e multirresistência bacteriana. MÉTODOS Estudo caso-controle em unidade de terapia intensiva neonatal do Estado do Ceará, entre janeiro de 2013 e dezembro de 2017. Considerado caso o recém-nascido notificado como IRAS tardia e, controle, aquele sem infecção. Variáveis com valor de p ≤ 0,05 em análise regressiva bivariada inicial foram incluídas em modelo logístico hierarquizado não condicional para análise multivariada. Valores de p menores que 0,01 foram considerados significativos. RESULTADOS Dos 1.132 participantes, 427 (37,7%) tiveram infecções tardias relacionadas a assistência à saúde, com 54 (12,6%) hemoculturas positivas e 14,9% dessas foram bactérias multirresistentes. Na análise bivariada observou-se efeito protetor do sexo feminino (OR = 0,71; IC95% 0,56–0,90) e recém-nascido ≥ 34 semanas (OR = 0,48; IC95% 0,30–0,75). Nos mais prematuros, as infecções tardias tiveram chance dezoito vezes maior em menores do que 30 semanas (OR = 18,61; IC95% 9,84–35,22); e nos menores de 1.500g, quatro vezes maior (OR = 4,18; IC95% 3,12–5,61). O uso de ventilação mecânica aumentou em mais de sete vezes a chance (OR = 7,14; IC95% 5,26–9,09); o mesmo aconteceu com o recurso da nutrição parenteral (OR = 5,88; IC95% 4,54–7,69), com o cateter venoso central (OR = 10,00; IC95% 6,66–16,66); o número de cateteres utilizado (OR = 3,93; IC95% 3,02–5,12); a realização de cirurgia (OR = 4,00; IC95% 2,27–7,14) e o tempo de internamento (OR = 1,06; IC95% 1,05–1,07). Permaneceram significativos após ajuste: prematuro menor do que 30 semanas (OR = 5,62; IC95% 1,83–17,28); uso de ventilação (OR = 1,84; IC95% 1,26–2,68); uso de cateter venoso central (OR = 2,48; IC95% 1,40–4,37) e tempo de internamento (OR = 1,06; IC95% 1,05–1,07). Dentre os óbitos, 41 (55,4%) foram associados às infecções tardias. CONCLUSÃO Melhores práticas devem ser adotadas no cuidado da prematuridade e o uso racional de procedimentos, para evitar infecções tardias relacionadas a assistência à saúde, óbitos preveníveis e riscos de multirresistência bacteriana e contaminação ambiental.

    Abstract in English:

    ABSTRACT OBJECTIVES To assess the determining factors of late healthcare-associated infections (HAIs) and bacterial multiple drug resistance in neonatal intensive care. METHODS This is a case-control study, conducted between January 2013 and December 2017, in a neonatal intensive care unit in the state of Ceará, Brazil. Newborns showing late HAIs were considered cases and those without infection, the control. Variables with p-values ≤ 0.05 in our initial bivariate regressive analysis were included in a non-conditional hierarchical logistic model for multivariate analysis. P-values below 0.01 were considered significant. RESULTS Of the 1,132 participants, 427 (37.7%) showed late healthcare-associated infections. Of these, 54 (12.6%), positive blood cultures, of which 14.9% contained multidrug-resistant bacteria. Bivariate analysis showed the protective effect of the feminine phenotype (OR = 0.71; 95%CI: 0.56–0.90) and of gestational ages ≥ 34 weeks (OR = 0.48; 95%CI: 0.30–0.75). In earlier-born preterm infants, late infections were 18 times more likely in those with less than 30 week-gestations (OR = 18.61; 95%CI: 9.84–35.22) and four times higher in those weighing less than 1,500 g (OR = 4.18; 95%CI: 3.12–5.61). Mechanical ventilation increased infection odds by more than seven times (OR = 7.14; 95%CI: 5.26–9.09); as did parenteral nutrition (OR = 5.88; 95%CI: 4.54–7.69); central venous catheters (OR = 10.00; 95%CI: 6.66–16.66); the number of catheters used (OR = 3.93; 95%CI: 3.02–5.12); surgery (OR = 4.00; 95%CI: 2.27–7.14); and hospitalization time (OR = 1.06; 95%CI: 1.05–1.07). The association between preterm infants with less than 30 week-gestations (OR = 5.62; 95%CI: 1.83–17.28); mechanical ventilation (OR = 1.84; 95%CI: 1.26–2.68); central venous catheters (OR = 2.48; 95%CI: 1.40–4.37); and hospitalization time (OR = 1.06; 95%CI: 1.05–1.07) remained significant after adjustment. Among deaths, 41 (55.4%) were associated with late infections. CONCLUSION Better practices should be adopted in caring for the premature, as well as in the rational use of procedures, to avoid late healthcare-associated infections, preventable deaths, and risks of bacterial multiple drug resistance and environmental contamination.
  • Food additives in childhood: a review on consumption and health consequences

    Kraemer, Mariana Vieira dos Santos; Fernandes, Ana Carolina; Chaddad, Maria Cecília Cury; Uggioni, Paula Lazzarin; Rodrigues, Vanessa Mello; Bernardo, Greyce Luci; Proença, Rossana Pacheco da Costa

    Abstract in Portuguese:

    RESUMO OBJETIVO Discutir o contexto das publicações científicas sobre consumo de aditivos alimentares por crianças e as possíveis consequências à saúde nessa faixa etária. MÉTODOS Revisão de literatura, com busca realizada entre abril de 2020 e abril de 2021 nas bases de dados Web of Science, Scopus, PubMed e Google Acadêmico, bem como em sites de órgãos oficiais brasileiros e estrangeiros. Foram selecionados documentos oficiais e estudos publicados a partir do ano 2000. Para a busca, foram utilizados unitermos relacionados a aditivos alimentares, crianças, consumo alimentar e saúde. RESULTADOS Aditivos alimentares são substâncias adicionadas intencionalmente aos alimentos para fins tecnológicos. Os alimentos industrializados são as principais fontes de aditivos na alimentação e seu consumo ocorre desde a infância. Observa-se, contudo, que há limitações inerentes ao método científico no que tange à análise de consumo e de toxicidade de aditivos alimentares em humanos, ocasionando escassez de dados na literatura científica. Adicionalmente, dados existentes sugerem que os aditivos apresentam potencial tóxico maior em crianças, considerando que o peso corporal nessa faixa etária é menor em relação ao adulto. Esse contexto ressalta a necessidade de se observar o princípio da precaução, segundo o qual devem-se prevenir os riscos de dano. CONCLUSÕES Trata-se de cenário no qual a literatura aponta risco à saúde das pessoas e, em especial, das crianças, cujo dever de proteção deve ser ainda maior, com absoluta prioridade. Assim, pondera-se a relevância de um debate técnico-científico ampliado quanto ao estabelecimento de parâmetros específicos e mais rígidos para crianças, considerando consumo e toxicidade de aditivos, bem como as diversas fontes de exposição a essas substâncias.

    Abstract in English:

    ABSTRACT OBJECTIVE To discuss the context of scientific publications on the consumption of food additives by children and the possible health consequences in this age group. METHODS A literature review, with a search carried out between April 2020 and April 2021 in the Web of Science, Scopus, PubMed and Google Scholar databases, as well as in websites of Brazilian and foreign official bodies. Official documents and studies published since 2000 were selected. Keywords related to food additives, children, food consumption, and health were used for the search. RESULTS Food additives are substances intentionally added to foods for technological purposes. Processed foods are the main sources of additives in food and their consumption occurs since childhood. It is observed, however, that there are limitations inherent to the scientific method regarding the analysis of consumption and toxicity of food additives in humans, causing scarcity of data in the scientific literature. Additionally, existing data suggest that the additives have a higher toxic potential in children, considering that the body weight in this age group is lower than in adults. This context emphasizes the need to observe the precautionary principle, according to which risks of harm must be prevented. CONCLUSIONS This is a scenario in which the literature points to a risk to people’s health and, in particular, to children, about whom the duty of protection must be even greater, with absolute priority. Thus, the relevance of an expanded technical-scientific debate regarding the establishment of specific and stricter parameters for children is considered, regarding the consumption and toxicity of additives, as well as the different sources of exposure to these substances.
  • Recent HIV infections: evaluation of a simple identification score for newly diagnosed patients Original Articles

    Matsuda, Elaine Monteiro; Ahagon, Cintia Mayumi; Coelho, Luana Portes Ozório; Campos, Ivana Barros de; Colpas, Daniela Rodrigues; Carmo, Andreia Moreira dos Santos; Brígido, Luís Fernando de Macedo

    Abstract in English:

    ABSTRACT OBJECTIVE Recognize incident infection to better characterize the groups that fuel HIV epidemic. We propose a simple score to identify recent infections among newly diagnosed patients as a HIV surveillance tool. METHODS Newly diagnosed patients were defined as recent infections when a negative serological test in the previous year was available. Laboratory tests, such as the avidity index (Bio-Rad, according to the CEPHIA protocol), chemiluminescent intensity (CMIA, architect, Abbott), and the nucleotide ambiguity index of partial pol sequences were used as proxies of recency. A simple score based on clinical symptoms of acute retroviral syndrome during the previous year, CD4+ T cell count, and viral load at admission was tested to assess the predictive power, using receiver operating characteristic (ROC) curves, to identify recent cases of infection. RESULTS We evaluated 204 recently diagnosed patients who were admitted to the Ambulatório de Referência em Moléstias Infecciosas de Santo André (Santo André Reference Infectious Diseases Outpatient Clinic), in the metropolitan region of São Paulo, Brazil, recruited between 2011 and 2018. An HIV-negative test in the year prior to enrollment was documented in 37% of participants. The proportion of cases classified as recent infections (less than one year), according to the laboratory proxies were: 37% (67/181) for an avidity index < 40%, 22% (30/137) for a CMIA < 200, and 68% (124/181) for an ambiguity index < 0.5%. Using different combinations of recency definitions, our score showed an area under the ROC curve from 0.66 to 0.87 to predict recency. CONCLUSIONS Using data from patients’ interviews and routine laboratory tests at admission, a simple score may provide information on HIV recency and thus, a proxy for HIV incidence to guide public policies. This simple for the Brazilian public health system and other low- and middle-income countries.
  • Gender and education inequalities in dynapenia-free life expectancy: ELSI-Brazil Original Articles

    Borges, Viviane Santos; Camargos, Mirela Castro Santos; Andrade, Fabíola Bof de

    Abstract in English:

    ABSTRACT OBJECTIVE To estimate the dynapenia-free life expectancy among community-dwelling older Brazilian adults and evaluate gender-related and educational differences. METHODS This is a cross-sectional study. The data were obtained from the Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brazil – Brazilian Longitudinal Study of Aging), conducted from 2015 to 2016 in Brazil. Dynapenia is defined as low muscle strength (< 27kg for men and < 16kg for women), measured with a handgrip dynamometer. The dynapenia-free life expectancy was estimated using the Sullivan method based on the standard period life table and dynapenia prevalence, stratified by age groups, gender, and schooling. RESULTS A total of 8,827 participants, aged 50 and over (53.3% women), were investigated. The prevalence of dynapenia was 17.7% among men and 18.5% among women. The women live longer and with more years free of dynapenia than men. Those in the higher education category (four or more years) presented an advantage in the dynapenia-free life expectancy estimates. CONCLUSIONS The results of this study suggest the substantial impact of dynapenia on longer dynapenia-free life expectancy among older people. Understanding dynapenia prevalence and dynapenia-free life expectancy could assist in predicting care needs, as well as targeting efforts to delay the onset of complications related to it at older ages. Without the implementation of policy regarding dynapenia prevention, inequalities in health due to gender and socioeconomic status may continue to increase.
  • Satisfaction of caregivers and older adults who use the Better at Home Program Original Articles

    Silva, Natália Romana Gomes da; Gurgel Junior, Garibaldi Dantas; Sá, Domício Aurelio de; Silva, Vanessa de Lima; Moreira, Rafael da Silveira

    Abstract in Portuguese:

    RESUMO OBJETIVO Avaliar a satisfação dos cuidadores e dos idosos usuários do serviço de atenção domiciliar por meio do Programa Melhor em Casa e seus fatores associados. METÓDOS Trata-se de um estudo transversal com dados da pesquisa nacional sobre o Programa Melhor em Casa, conduzida pela Ouvidoria Geral do SUS. Foram entrevistados 5.595 cuidadores e 950 idosos. Quatro perguntas relacionadas à satisfação foram unidas para formulação da variável dependente por meio da análise de classes latentes e 13 perguntas foram utilizadas como variáveis independentes. RESULTADOS Mostraram-se satisfeitos com o serviço, 93,7% dos idosos e 90,2% dos cuidadores. Na análise múltipla, as variáveis que apresentaram associação com a satisfação foram: também ser acompanhados por uma equipe de saúde da família (idoso: OR = 4,22; p = 0,014), menor tempo entre o encaminhamento e a primeira visita (idoso: OR = 10,20; p = 0,006), (cuidador: OR = 5,84; p < 0,001), realização de exames quando havia solicitação médica (idoso: OR = 5,74; p = 0,037), (cuidador: OR = 7,41; p < 0,001), realização de consulta com especialista (cuidador: OR = 6,02; p < 0,001), ter visitas fora do horário agendado quando fosse necessário (idoso: OR = 8,09; p = 0,014), (cuidador: OR = 1,81; p = 0,015) e compreender as orientações que eram passadas pela equipe do programa (cuidador: OR = 10,61; p < 0,001). CONCLUSÕES Constatou-se que a maioria dos idosos e dos cuidadores demonstraram satisfação com o programa, havendo distinção nos aspectos associados a essa satisfação, nos quais apenas as características diretamente relacionadas ao programa influenciaram na satisfação, não ocorrendo o mesmo com as características socioeconômicas e demográficas.

    Abstract in English:

    ABSTRACT OBJECTIVE Evaluate the satisfaction of caregivers and older adults who use the home care service provided by the Better at Home Program (Programa Melhor em Casa) and its associated factors. METHODS This is a cross-sectional study with data from the national survey on the Better at Home Program, conducted by the SUS General Ombudsman. We interviewed 5,595 caregivers and 950 older adults. We combined four questions related to satisfaction to formulate the dependent variable by means of latent class analysis and used 13 questions as independent variables. RESULTS 93.7% of the older adults and 90.2% of the caregivers were satisfied with the service. In the multiple analysis, the variables showing association with satisfaction were: also being accompanied by a family health team (older adults: OR = 4.22; p = 0.014), shorter time between referral and the first visit (older adults: OR = 10.20; p = 0.006), (caregiver: OR = 5.84; p < 0.001), taking examinations with medical requirement (older adults: OR = 5.74; p = 0.037), (caregiver: OR = 7.41; p < 0.001), consultation with specialist (caregiver: OR = 6.02; p < 0.001), visits out of the schedule when necessary (older adults: OR = 8.09; p = 0.014), (caregiver: OR = 1.81; p = 0.015) and understanding the orientations provided by the program team (caregiver: OR = 10.61; p < 0.001). CONCLUSIONS The majority of the older adults and caregivers showed satisfaction with the program, with a distinction in the aspects associated with this satisfaction, in which only the characteristics directly related to the program influenced the satisfaction, while the same did not occur with the socioeconomic and demographic characteristics.
  • Kashmiri refugees at the verge of hepatitis B and C epidemic in the State of Azad Jammu and Kashmir, Pakistan Original Articles

    Kazmi, Syed Ayaz; Rauf, Abdul; Shafique, Farheen; Asim, Noreen; shafi, Nuzhat; Hassan, Mahreen Ul

    Abstract in English:

    ABSTRACT OBJECTIVE To determine the seroprevalence of hepatitis B and C among immigrants residing refugee camps in Muzaffarabad, Azad Kashmir, Pakistan, and to identify possible risk factors for hepatitis B virus (HBV) and hepatitis C virus (HCV) transmission. METHODS Around 1,225 individuals inhabiting Muzaffarabad refugee camps, participated in the study. A qualitative Immuno-Chromatographic Technique was used for initial screening and PCR test was used for detection of HBV and HCV in participants. The major risk factors for HBV and HCV transmission were assessed using a questionnaire approach. RESULTS Around 86 (7.0%) individuals were observed for hepatitis B surface antigen (HBsAg) presence, and 215 (17.5%) individuals were found positive for Anti-HCV. Only 32 (2.6%) individuals were confirmed for HBV DNA and 126 (10.3%) individuals were positive for HCV RNA after PCR. Demographically, both HBsAg and Anti-HCV were found more prevalent in female (4.4% HBsAg and 10.8% Anti-HCV) population as compared to male (2.6% HBsAg and 6.7% Anti-HCV) population. Surprisingly, the HBsAg (23.5%) and Anti-HCV (41.1%) appeared to be more frequent in the age group 62–75 years. Previous history of hepatitis in the family (p < 0.0001), blood transfusion (p = 0.0197) dental treatment (p < 0.0001) and tattooing or piercing on any part of the body (p = 0.0028) were assessed as significant risk factors in HBV and HCV transmission. CONCLUSIONS Presence of 7.0% HBsAg and 17.5% Anti-HCV in a small fragment of the migrant population cannot be overlooked. Lack of awareness among people and negligence of health department could escalate the situation.
  • Implementation of Group Interpersonal Psychotherapy in primary care Original Articles

    Mattos, Maria Isabel Perez; Mosqueiro, Bruno Paz; Stuart, Scott; Salum, Giovanni; Duzzo, Rosana de Lima; Souza, Laura Wolf de; Chini, Ariane; Fleck, Marcelo Pio de Almeida

    Abstract in English:

    ABSTRACT OBJECTIVE To show the implementation process of IPT-G in primary care, including facilitating and obstructing factors, implementation strategies, and training and supervision of primary care professionals. METHODS Quantitative (cross-sectional and longitudinal) analysis of pre and post-knowledge tests; qualitative analyses of the training courses; patient recruitment; conduction of IPT-G sessions; supervision of IPT-G therapists; application of a semi-structured questionnaire to assess, investigate, and develop strategies against the identified barriers. RESULTS About 120 clinicians answered the pre-test; 84 completed the post-test. Pre- and post-test scores of IPT-G knowledge were significantly different. Twenty initially trained clinicians completed additional supervision in IPT-G. Qualitative analysis identified twelve barriers and six facilitators to IPT-G implementation in individual, organizational, and systemic contexts. CONCLUSIONS Implementation of IPT-G in primary care is a complex process with several steps. In the first step, health professionals were successfully trained in IPT-G. However, subsequent steps were more complex. Therefore, careful planning of IPT-G implementation is essential to maximize the success of this innovation.
  • Profile and Migration of Members of Residency Programs in Family Medicine Original Articles

    Leite, Ana Paula Tussi; Mai, Scheila; Waquil, Alice Paul; Cordero, Elvira Alicia Aparicio; Rosa, Vitória Silva da; Daudt, Carmen Vera Giacobbo; Wander, Brenda; Pinto, Maria Eugênia Bresolin; Correia, Isabel Brandão; Sarti, Thiago Dias

    Abstract in Portuguese:

    RESUMO OBJETIVO Caracterizar o perfil sociodemográfico e analisar as características migratórias dos integrantes dos Programas de Residência em Medicina de Família e Comunidade em 2020 no Brasil. MÉTODOS O estudo segue um delineamento observacional transversal de natureza quantitativa a partir da perspectiva dos integrantes dos Programas de Residência em Medicina de Família e Comunidade. Foram desenvolvidos questionários adaptados para cada grupo participante, aplicados por meio de plataforma on-line. RESULTADOS A maioria dos participantes é do sexo feminino e de cor branca. A maioria dos supervisores e preceptores foi residente de Programas de Residência em Medicina de Família e Comunidade, contudo, há alguns que não são especialistas na área. A maior parte dos participantes está vinculada às capitais ou regiões metropolitanas. Em relação à fixação, 41,1% dos supervisores e 73,1% dos preceptores estão vinculados a um programa no mesmo município onde foram residentes. Para a maioria dos médicos residentes, o local da residência coincide com o local de nascimento e/ou graduação (57,4%), sendo que 48,5% estão no mesmo local de graduação. CONCLUSÕES A pesquisa reforça a necessidade de políticas de promoção da migração de residentes para Programas de Residência em Medicina de Família e Comunidade fora das capitais e regiões metropolitanas, bem como estimula a fixação dos egressos formados fora dos grandes centros urbanos para que eles possam contribuir com a distribuição e com o provimento de médicos onde ainda é necessário.

    Abstract in English:

    ABSTRACT OBJECTIVE To describe the sociodemographic profile and analyze the migratory characteristics of the members of the Residency Programs in Family Medicine in 2020 in Brazil. METHODS The study follows a cross-sectional observational design of a quantitative nature from the perspective of the members of the Residency Programs in Family Medicine. Questionnaires adapted for each participating group were developed, applied through an online platform. RESULTS Most participants are female and white. Most supervisors and preceptors were residents of Residency Programs in Family Medicine, however, there are some who are not specialists in the field. Most participants are based in capitals or metropolitan regions. In relation to retention, 41.1% of supervisors and 73.1% of preceptors are affiliated to a program in the same municipality where they lived. For most resident physicians, the place of residence coincides with the place of birth and/or graduation (57.4%), and 48.5% are in the same place of graduation. CONCLUSIONS The research reinforces the need for policies to promote the migration of residents to Residency Programs in Family Medicine outside capital cities and metropolitan regions, as well as encouraging the retention of graduates trained outside large urban centers so that they can contribute to distribution and provision of doctors where they are still needed.
  • Systemic autoimmune diseases and work outcomes in Brazil: a scoping review

    Cordeiro, Rafael Alves; Fischer, Frida Marina; Shinjo, Samuel Katsuyuki

    Abstract in English:

    ABSTRACT OBJECTIVE To review articles that assessed work-related outcomes such as workability, work productivity, presenteeism, absenteeism, sick leave, return to work, and employment status of Brazilian patients with rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, Sjögren’s syndrome, and systemic autoimmune myopathies. METHODS This study was conducted in Medline databases (PubMed), SciELO, and Lilacs through a combination of descriptors of interest. Studies published until December 2020 were considered in the search strategy. RESULTS Eight out of 90 articles met the eligibility criteria and were included in this review. The studies are highly heterogeneous. Most of them are cross-sectional, and all of them address rheumatoid arthritis or systemic lupus erythematosus. A common denominator among these studies is the high proportion of patients outside the labor market. CONCLUSIONS In general, the studies show unfavorable labor outcomes and impaired participation in the Brazilian workforce among the samples of patients assessed. There is a need to better understand several topics about Brazilian patients with systemic autoimmune diseases and their work context, as well as to conduct studies focusing on rarer diseases and on the themes of return and reintegration to work.
  • Hepatitis A and E among immigrants and refugees in Central Brazil Original Articles

    Silva, Grazielle Rosa da Costa e; Martins, Thaynara Lorrane Silva; Silva, Carla de Almeida; Caetano, Karlla Antonieta Amorim; Carneiro, Megmar Aparecida dos Santos; Silva, Bruno Vinicius Diniz e; Pacheco, Leonora Rezende; Villar, Livia Melo; Paula, Vanessa Salete de; Martins, Regina Maria Bringel; Teles, Sheila Araújo

    Abstract in English:

    ABSTRACT OBJECTIVE To estimate the prevalence of hepatitis A virus (HAV) and hepatitis E virus (HEV) among immigrants and refugees in Goiás, Central Brazil. METHODS Overall, 355 individuals were interviewed, and blood samples were tested for anti-HAV and anti-HEV IgG. Anti-HEV-positive samples were similarly tested for HEV RNA. RESULTS All participants were from Latin American countries, most of whom, young adult males. The overall anti-HAV IgG prevalence was 87.4% (95%CI: 83.5–90.4), of whom 94.9%, 75.6%, and 60% were from Haiti, Venezuela, and other Latin American countries, respectively (p < 0.001). Age above 19 years and more than 36 months residing in Brazil were associated with a higher prevalence of previous HAV and HEV infection, respectively. Of the children eligible for HAV vaccination according to the National Immunization Program, only eight (44%) had been vaccinated. The overall anti-HEV IgG prevalence was 6.5% (95%CI: 4.4–9.5). All anti-HEV IgG-positive individuals were Haitians, including a child born in Brazil. HEV RNA was detected in two of the anti-HEV IgG-positive samples. CONCLUSION The survey detected a high prevalence of anti-HAV and anti-HEV IgG among immigrants and refugees, and active HEV infection among some Haitian participants. Prevention measures are urgently required to interrupt enteric virus transmission in this emergent and vulnerable population.
  • ELSA-Brasil: a 4-year incidence of hearing loss in adults with and without hypertension Original Articles

    Padilha, Fernanda Yasmin Odila Maestri Miguel; Oenning, Nágila Soares Xavier; Santos, Itamar de Souza; Rabelo, Camila Maia; Moreira, Renata Rodrigues; Bensenor, Isabela M.; Lotufo, Paulo A.; Samelli, Alessandra Giannella

    Abstract in English:

    ABSTRACT OBJECTIVE To compare the incidence of hearing loss among adults stratified by the occurrence of hypertension, and to investigate the association between hypertension and hearing loss. METHODS Longitudinal observational study, part of the Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil, Longitudinal Study on Adult’s Health). Data from the first and second waves were analyzed, including information from audiological assessment and general health of the subjects. As outcome, we considered the presence of hearing loss (hearing thresholds above 25 dBHL at frequencies from 500 Hz to 8 kHz) and, as exposure variable, hypertension (report of medical diagnosis of hypertension; and/or use of drugs to treat hypertension; and/or pressure systolic blood pressure ≥ 140 mmHg; or diastolic blood pressure ≥ 90 mmHg). As covariables for adjustment were considered: sex, age, education, race / ethnicity, income, smoking, diabetes, and occupational exposure to noise. Poisson regression analysis was conducted, estimating the crude and adjusted relative risks, with 95% confidence intervals, in order to assess the factors associated with hearing loss. RESULTS In crude analyses, the incidence of hearing loss was higher for subjects with hypertension (9.7% versus 5.4%). The crude relative risks for hearing loss was almost double (1.93; 95%CI: 1.10–3.39) for subjects with hypertension in the right ear. In the adjusted analyses, the relative risks was not significant for the hypertension variable (1.42; 95%CI: 0.75–2.67). Being 60 years or older (RR: 5.41; 95%CI: 2.79–10.50) showed a statistically significant association with hearing loss, indicating that older adults have higher relative risks for hearing loss. CONCLUSION In the adjusted analyses controlled for multiple risk factors there was no association between hypertension and hearing loss. The dichotomous variable age (being 60 years or older), on the other hand, has shown a significant association with hearing loss.
  • Episiotomy in Southern Brazil: prevalence, trend, and associated factors Original Articles

    Cesar, Juraci A.; Marmitt, Luana P.; Mendoza-Sassi, Raúl A.

    Abstract in English:

    ABSTRACT OBJECTIVE To identify and analyze the prevalence, trend, and factors associated with episiotomy in Rio Grande, in the state of Rio Grande do Sul, Southern Brazil. METHODS A single, standardized questionnaire was applied to all pregnant women, residents in the municipality of Rio Grande, who had children in local hospitals between January 1 and December 12 of the years 2007, 2010, 2013, 2016 e 2019. Demographic and socioeconomic characteristics were investigated, as well as the assistance received during pregnancy and delivery. Chi-square test was used to compare proportions and Poisson regression with robust variance adjustment was used for multivariable analysis. Prevalence ratio (PR) was used as effect measure. RESULTS Among the 12,645 births that occurred in the five years, 5,714 (45.2%) were vaginal delivery. Of these mothers, 2,930 (51.3%; 95%CI: 50.0%–52.6%) underwent episiotomy. Over this period, the episiotomy rate decreased from 70.9% (68.4–73.5) in 2007 to 19.4% (17.1–21.7) in 2019. Adjusted analysis showed a high PR of episiotomy occurrence among women who were young (PR = 2.23; 95%CI: 1.89–2.63), had higher education (PR = 1.21; 95%Cl: 1.03–1.42), had a higher family income (PR = 1.25; 95%CI: 1.10–1.41), were primiparous (PR = 3.41; 95%CI: 2.95–3.95), had prenatal care in the private sector (PR = 1.25; 95%CI: 1.07–1.46), had oxytocin-induced labor (PR = 1.18; 95%CI:1.09–1.27), underwent forceps (PR = 1.32; 95%CI: 1.16–1.50), and whose newborn weighed 4,000 g or more (PR = 1.43; 95%CI: 1.14–1.80). CONCLUSION Although the prevalence of episiotomy fell sharply within the studied period, its occurrence is more likely among women at lower risk of birth complications.
  • Sociodemographic and health profile of asylum-seekers in Rio de Janeiro, 2016–2017 Original Articles

    Cavalcante, João Roberto; Proença, Raquel; Cano, Ignacio; Trajman, Anete; Faerstein, Eduardo

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar o perfil sociodemográfico e as condições de saúde autorrelatadas por solicitantes de refúgio no Rio de Janeiro. MÉTODOS Estudo transversal de dados secundários, coletados de formulários de solicitação de refúgio preenchidos em 2016 e 2017, na Cáritas Arquidiocesana do Rio de Janeiro (Cáritas-RJ). Foram realizadas análises descritivas e calculadas frequências absolutas, relativas e intervalos de 95% de confiança. RESULTADOS Foram identificados formulários preenchidos por 818 solicitantes de refúgio, originários de 49 países diferentes, dos quais 126 (20,3%) eram apátridas, 510 (62,7%) do sexo masculino, 797 (97,4%) adultos, com idade média de 30,5 anos, 551 (73,5%) solteiros, 340 (44,1%) com ensino superior e 27 (4,0%) desempregados no país de origem antes da vinda para o Brasil. Entre os motivos declarados para solicitação de refúgio, destacaram-se o temor de perseguição por opinião política, violação de direitos humanos e risco de tortura. Para chegar ao Brasil, 629 (80,5%) viajaram somente de avião. Em relação às condições de saúde, 216 (29,0%) afirmaram ter algum sintoma, doença ou agravo em saúde, sendo as mais frequentes dores, problemas de visão, doenças infecciosas (incluindo HIV/aids) e hipertensão. Apenas 15 indivíduos (2,2%) relataram estar em algum tratamento médico ou psicológico; 42 (6,0%) relataram deficiências visuais, 14 (2,0%) relataram deficiências físicas e 4 (0,6%) deficiências auditivas. CONCLUSÕES Diferentemente de outros países, onde migrantes forçados de baixo grau de instrução entram por vias clandestinas marítimas ou terrestres, os solicitantes de refúgio residentes no Rio de Janeiro entre 2016 e 2017, eram, em sua maioria, adultos com ensino superior que migraram usando transporte aéreo. Apresentavam condições de saúde sensíveis à atenção primária que poderiam ser tratadas via acesso aos serviços públicos da atenção primária em saúde.

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze the sociodemographic profile and self-reported health conditions of asylum-seekers in Rio de Janeiro. METHODS A cross-sectional study of secondary data, collected from asylum claims forms completed in 2016 and 2017, at Cáritas Arquidiocesana do Rio de Janeiro (Cáritas-RJ). Descriptive analyses were performed and absolute and relative frequencies and 95% confidence intervals were calculated. RESULTS Claims completed by 818 asylum-seekers from 49 different countries were identified, of whom 126 (20.3%) were stateless, 510 (62.7%) were male, 797 (97.4%) were adults, with a mean age of 30.5 years, 551 (73.5%) were single, 340 (44.1%) had higher education, and 27 (4.0%) were unemployed in their country of origin before coming to Brazil. Fear of persecution for political opinion, violation of human rights, and risk of torture stood out among the reasons stated for requesting asylum. To reach Brazil, 629 (80.5%) traveled only by plane. Regarding health conditions, 216 (29.0%) reported having some symptom, disease or health problem, the most frequent being pain, vision problems, infectious diseases (including HIV/AIDS), and hypertension. Only 15 individuals (2.2%) reported being in some medical or psychological treatment; 42 (6.0%) reported visual impairments, 14 (2.0%) reported physical impairments and 4 (0.6%) hearing impairments. CONCLUSIONS Unlike other countries, where forced migrants with a low level of education enter clandestinely by sea or land, asylum-seekers residing in Rio de Janeiro between 2016 and 2017 were mostly adults with higher education who migrated using air transport. They had primary care-sensitive health conditions that could be treated via access to public primary health care services.
  • Analysis of trends in sepsis mortality in Brazil and by regions from 2010 to 2019 Original Articles

    Almeida, Nyara Rodrigues Conde de; Pontes, Giovana Fonseca; Jacob, Felipe Lima; Deprá, João Victor Salvador; Porto, João Pedro Pires; Lima, Fernanda Rocha de; Albuquerque, Mário Roberto Tavares Cardoso de

    Abstract in Portuguese:

    RESUMO OBJETIVO Caracterizar o perfil dos pacientes internados e a tendência de mortalidade por sepse no Sistema Único de Saúde (SUS), em todo Brasil e em suas regiões separadamente, entre os anos de 2010 e 2019. MÉTODOS Estudo observacional, analítico e retrospectivo de dados secundários obtidos por consulta ao Sistema de Informação Hospitalar. Foram incluídas todas as notificações por septicemia admitidas entre 1 de janeiro de 2010 e 31 de dezembro de 2019. Utilizou-se as variáveis sociodemográficas: sexo, idade, raça, região e unidade federativa de residência. Para a análise dos dados, utilizou-se coeficiente de mortalidade e de internação, risco relativo e regressão por Joinpoints. RESULTADOS Totalizaram-se 1.044.227 casos de sepse no país, perfazendo um coeficiente de prevalência média de 51,3/100 mil habitantes. Foram registrados 463 mil óbitos por sepse, com coeficiente médio de 22,8 óbitos/100 mil habitantes. As maiores taxas ocorreram entre os idosos, de raça parda e não houve uma diferença significativa entre os sexos. A Região Sudeste foi responsável pelo maior índice de internação e óbitos. Observou-se uma tendência geral de aumento da mortalidade no período estudado. CONCLUSÃO Cabe considerar a heterogeneidade do Brasil, no que concerne às características socioeconômicas e demográficas e às diferenças de investimento em saúde e de subnotificações entre as regiões, a fim de entender o traçado epidemiológico da doença. Por fim, é necessário correlacionar esses achados com demais estudos, buscando entendimento do comportamento da doença e embasamento para políticas públicas e privadas, com intuito de diminuir a expressividade de casos e óbitos por sepse no país.

    Abstract in English:

    ABSTRACT OBJECTIVE To characterize the profile of inpatients and trend of sepsis mortality in the Brazilian Unified Health System (SUS), throughout Brazil, and in its regions separately, from 2010 to 2019. METHODS Observational, analytical and retrospective study of secondary data obtained through consultation to the Sistema de Informação Hospitalar (Hospital Information System). All incoming septicemia notifications from January 1, 2010 to December 31, 2019 were included. The following sociodemographic variables were used: sex, age, race, region and federative unit of residence. For data analysis, we used mortality and hospitalization coefficient, relative risk and Joinpoint regression. RESULTS There were a total of 1,044,227 cases of sepsis in Brazil, yielding a mean prevalence coefficient of 51.3/100 thousand inhabitants. There were 463,000 deaths from sepsis recorded, with a mean prevalence coefficient of 22.8 deaths/100,000 inhabitants. The highest rates occurred among the elderly, of brown race, and there was no significant difference between genders. The Southeast region accounted for the highest rates of hospitalization and deaths. A general trend toward increased mortality was observed in the period studied. CONCLUSION The heterogeneity of Brazil should be considered regarding socioeconomic and demographic characteristics, and differences in health investment and underreporting between regions, in order to understand the disease’s epidemiological course. Finally, these findings should be correlated with other studies, in an effort to understand the behavior of the disease, and provide inputs for public and private policies in order to reduce the expressiveness of cases and deaths from sepsis in Brazil.
  • Covid-19 in Brazil in 2020: impact on deaths from cancer and cardiovascular diseases Original Articles

    Jardim, Beatriz Cordeiro; Migowski, Arn; Corrêa, Flávia de Miranda; Silva, Gulnar Azevedo e

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar o impacto da pandemia de covid-19 sobre a mortalidade por câncer e por doenças cardiovasculares (DCV) como causa básica e comorbidade no Brasil e em suas regiões em 2020. MÉTODOS Foram utilizadas as bases de dados de 2019 e 2020 do Sistema de Informações de Mortalidade (SIM), analisando os óbitos ocorridos entre março e dezembro de cada ano que tiveram o câncer e as DCV como causa básica ou como comorbidade. Também foram analisados os óbitos por covid-19 em 2020. Para o cálculo da Razão de Mortalidade Padronizada (RMP) e estimativa do excesso de mortes, os dados de 2019 foram considerados como padrão. RESULTADOS Entre março e dezembro de 2020 ocorreram no Brasil 181.377 mortes por câncer e 291.375 mortes por doenças cardiovasculares, indicando redução de 9,7% e de 8,8%, respectivamente, em relação ao mesmo período do ano anterior. O padrão foi mantido nas cinco regiões brasileiras, com menor variação para o câncer (-8,4% na Região Sul a -10,9% na Região Centro-Oeste). Para as DCV houve uma maior variação, de -2,2% na Região Norte até -10,5 nas regiões Sudeste e Sul. No mesmo período de 2020, essas enfermidades foram classificadas como comorbidade em 18.133 óbitos por câncer e 188.204 óbitos por doenças cardiovasculares, indicando um excesso proporcional, se comparado aos dados de 2019, de 82,1% e 77,9%, respectivamente. Esse excesso foi mais expressivo na Região Norte, com razão de 2,5 entre mortes observadas e esperadas, para as duas condições estudadas. CONCLUSÕES O excesso de óbitos por câncer e DCV como comorbidade em 2020 pode indicar que a covid-19 teve um importante impacto entre pacientes portadores dessas condições.

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze the impact of the covid-19 pandemic on mortality from cancer and cardiovascular diseases (CVD) as underlying cause and comorbidity in Brazil and Brazilian regions in 2020. METHODS We used the 2019 and 2020 databases of the Mortality Information System (SIM) to analyze deaths occurring between March and December of each year that had cancer or CVD as the underlying cause or comorbidity. Deaths from covid-19 in 2020 were also analyzed. To estimate the Standardized Mortality Ratio (SMR) and the excess of deaths, 2019 data were considered as standard. RESULTS Between March and December 2020, there were 181,377 deaths from cancer and 291,375 deaths from cardiovascular diseases in Brazil, indicating reduction rates of 9.7% and 8.8%, respectively, compared to the same period of the previous year. The pattern was maintained in the five Brazilian regions, with lower variation for cancer (-8.4% in the South to -10.9% in the Midwest). For CVD, the variation was greater, from -2.2% in the North to -10.5 in the Southeast and South. In the same period of 2020, these diseases were classified as comorbidities in 18,133 deaths from cancer and 188,204 deaths from cardiovascular diseases, indicating a proportional excess compared to data from 2019, of 82.1% and 77.9%, respectively. This excess was most significant in the Northern Region, with a ratio of 2.5 between observed and expected deaths for the two conditions studied. CONCLUSIONS Excess deaths from cancer and CVD as comorbidities in 2020 may indicate that covid-19 had an important impact among patients with these conditions.
  • Theoretical report: reflections and considerations for authors, reviewers, and editors Comments

    Souza Filho, Breno Augusto Bormann de; Tritany, Érika Fernandes; Struchiner, Cláudio José

    Abstract in Portuguese:

    RESUMO Atualmente, os estudos epidemiológicos voltados à saúde pública têm apresentado limitações importantes quanto ao relato teórico em profundidade, frente a uma supervalorização de aspectos metodológicos. A falta de explicitação teórica nas publicações, afeta não apenas a qualidade do estudo, como também sua reprodutibilidade. Nesse sentido, apoiados em uma revisão da literatura científica acerca do tema, apresentamos neste ensaio reflexões sobre a importância do relato teórico aprofundado, relacionado à fundamentação teórica adotada por pesquisadores nas principais seções do manuscrito (título, resumo, introdução, metodologia, resultados, discussão e conclusão). Acreditamos que este artigo pode favorecer a compreensão sobre a importância e desenvolvimento de relatos teóricos aprofundados em artigos científicos e contribuir para avaliações, interpretações e críticas dos revisores e editores em relação à importância da explicitação e do relato da fundamentação teórica nos manuscritos submetidos aos periódicos científicos.

    Abstract in English:

    ABSTRACT Epidemiological studies focused on public health have currently shown significant limitations regarding in-depth theoretical reports, overvaluing methodological aspects. The lack of theoretical explanation affects both the quality and reproducibility of studies. This study therefore reflected on the importance of in-depth theoretical reports considering the theoretical foundation used by researchers in the main sections of the manuscript (title, abstract, introduction, methodology, results, discussion, and conclusion) based on a review of the scientific literature on the subject. We believe that this article can help understand the importance and the development of in-depth theoretical reports in scientific articles, contributing to assessments, interpretations, and criticisms of reviewers and editors regarding the explanation and reporting of theoretical foundation in manuscripts submitted to scientific journals.
  • Territory, neglected diseases and the action of community and endemic combat agents Original Articles

    García, Gabriela Soledad Márdero; Souza, Eliana Amorim de; Araújo, Vigna Maria de; Macedo, Mariana Sousa Santos; Andrade, Rosélly Mascarenhas Amaral de; Ferreira, Paulo Rogers da Silva; Guimarães, Maria Cristina Soares; Silva, José Alexandre Menezes da; Ramos Júnior, Alberto Novaes

    Abstract in Portuguese:

    RESUMO OBJETIVO Caracterizar conhecimentos, práticas e experiência profissional de agentes comunitários de saúde (ACS) e agentes de controle de endemias (ACE) sobre hanseníase e doença de Chagas (DC), durante participação em oficina de formação integrada no projeto IntegraDTNs-Bahia. MÉTODOS Estudo de caso descritivo e exploratório, envolvendo comunitários de saúde e agentes de controle de endemias, participantes de oficina de formação sobre o papel compartilhado desses profissionais no processo de vigilância e atenção à saúde. Projeto desenvolvido nos municípios de Anagé, Tremedal e Vitória da Conquista, no Sudoeste do Estado da Bahia, 2019–2020. Aplicou-se instrumento específico prévio com questões relativas a conhecimentos e práticas de vigilância e atenção para hanseníase e doença de Chagas. Análise descritiva dos dados, além de consolidação da análise léxica. RESULTADOS Do total de 135 participantes (107 ACS e 28 ACE), 80,7% deles atuam há pelo menos 12 anos, sem participação prévia em processos de formação conjunta. Apenas 17,9% dos agentes de controle de endemias relataram ter participado de capacitações sobre hanseníase e nenhum informou desenvolver ações específicas de controle da doença. Para a doença de Chagas, 36,4% dos agentes comunitários de saúde participaram de capacitações há mais de uma década, enquanto para 60,7% dos agentes de controle de endemias a última capacitação foi realizada nos últimos cinco anos. O desenvolvimento de ações educativas para a doença de Chagas foi mais frequente para agentes de controle de endemias (64,3%). Quando perguntados sobre formas de reconhecimento das doenças, a palavra “manchas na pele” foi a mais relatada (38 vezes) para hanseníase e, para a doença de Chagas, a palavra “não sei” (17 vezes). CONCLUSÃO Os processos de atuação de agentes comunitários de saúde e agentes de controle de endemias em realidades endêmicas para hanseníase e doença de Chagas no interior da Bahia revelaram-se desintegrados nos territórios. Para essas doenças, reforça-se o distanciamento entre ações de vigilância e de atenção à saúde, inclusive nos processos de capacitação. Reitera-se a importância de ações inovadoras de educação permanentes e integradas para promover de fato mudanças nas práticas.

    Abstract in English:

    ABSTRACT OBJECTIVE To characterize knowledge, practices, and professional experience of community health agents (ACS) and endemic combat agents (ACE) on leprosy and Chagas disease (DC), during participation in an integrated training workshop in the IntegraDTNs-Bahia project. METHODS Descriptive and exploratory case study, involving health agents and endemic combat agents participating in a training workshop on the shared role of these professionals in health care and surveillance processes. The project was developed in the municipalities of Anagé, Tremedal and Vitória da Conquista, in the southwestern State of Bahia, 2019–2020. A specific instrument was applied, with questions related to knowledge and practices of surveillance and care for leprosy and Chagas disease. Descriptive analysis of the data, in addition to consolidation of the lexical analysis, was performed. RESULTS Out of a total of 135 participants (107 ACS and 28 ACE), 80.7% of them have been working for at least 12 years, without previous participation in joint training processes. Only 17.9% of endemic combat agentes reported having participated in training on leprosy and none reported developing specific actions to control the disease. For Chagas disease, 36.4% of community health agents participated in training more than a decade before, while for 60.7% of endemic combat agents the last training was carried out in the last five years. The development of educational actions for Chagas disease was more frequent for endemic combat agents (64.3%). When asked about ways of recognizing diseases, the term “skin spots” was the most reported (38 times) for leprosy and, for Chagas disease, the term “I don’t know” (17 times). CONCLUSION Processes of health agents and endemic combat agents action in realities endemic for leprosy and Chagas disease in the interior of Bahia proved to be fragmented in the territories. For these diseases, the distance between surveillance and health care actions is reinforced, including in training processes. The importance of innovative permanent and integrated education actions is reiterated to actually promote changes in practices.
  • Conditions of employment, work and quality of life of men and women in informal jobs Original Articles

    Besoain-Saldaña, Álvaro; Flores, Gustavo Agurto; Muñoz, Tiare Alarcón; Sanhueza, Jame Rebolledo

    Abstract in Spanish:

    RESUMEN OBJETIVO Identificar brechas de género en las condiciones de empleo, trabajo y calidad de vida de vendedores informales de la Vega Central de Chile. MÉTODOS Se realizó un estudio transversal con ochenta trabajadores, quienes respondieron módulos de la Encuesta Nacional de Condiciones de Empleo, Trabajo y Salud (ENETS) y al Cuestionario de Salud SF-36 para la recolección de datos. Se hizo un análisis descriptivo para determinar características de la población y la prueba de Chi-cuadrado para estudiar correlaciones entre cada una de las variables con el género. RESULTADOS De la muestra, cincuenta (62,5%) pertenecen al género masculino, y treinta (37,5%) al género femenino. Ambos grupos presentan condiciones de empleo, trabajo y calidad de vida similares. No obstante, las mujeres manifiestan mayor temor que los hombres a reclamar mejores condiciones de trabajo, así como más desánimo y tristeza durante la jornada y peor percepción de estado de salud. CONCLUSIONES Las estrategias de promoción y prevención de salud laboral y seguridad social deben considerar una perspectiva de género sobre las condiciones laborales e indicadores de salud, que permitan a mujeres desarrollar herramientas para demandar justas condiciones y promuevan obligaciones al empleador de preocuparse del bienestar de trabajadores y trabajadoras.

    Abstract in English:

    ABSTRACT OBJECTIVE Identify gender gaps in the employment conditions, work and quality of life of informal sellers in Vega Central of Chile. METHODS We conducted a cross-sectional study with eighty workers, who answered modules of the Encuesta Nacional de Condiciones de Empleo, Trabajo y Salud (ENETS – National Survey of Employment, Work and Health Conditions) and the SF-36 Health Questionnaire for data collection. We performed a descriptive analysis to determine the characteristics of the population and the Chi-square test to study correlations between each of the variables with gender. RESULTS Of the sample, fifty (62.5%) are male and thirty (37.5%) are female. Both groups have similar conditions of employment, work and quality of life. However, women express greater fear than men do with respect to demanding better working conditions, as well as more discouragement and sadness during the workday and a worse perception of their state of health. CONCLUSIONS Strategies for the promotion and prevention of occupational health and social security should consider a gender perspective on working conditions and health indicators, allowing women to develop tools to demand fair conditions and promote employer obligations to care for the well-being of male and female workers.
  • Tobacco-related neoplasms: survival analysis and risk of death of population data from Florianópolis, SC Original Articles

    Schneider, Ione Jayce Ceola; Schmidt, Tauana Prestes; Correa, Vanessa Pereira; Santos, Ana Maria Martins dos; Rocha, Bruna Vanti da; Garcia, Leandro Pereira; Ceccon, Roger Flores

    Abstract in Portuguese:

    RESUMO OBJETIVO Estimar a probabilidade de sobrevivência e os fatores prognósticos das neoplasias relacionados ao tabagismo em uma coorte de base populacional. MÉTODOS Trata-se de uma coorte com dados do Registro de Câncer de Base Populacional de Florianópolis, região Sul do Brasil, de 2008 a 2012. Utilizou-se o software Stata 16.0 para estimar as probabilidades de sobrevivência em cinco anos após o diagnóstico, pelo método de Kaplan Meier, e os riscos de óbito, pela regressão de Cox. RESULTADOS Foram incluídos 2.829 registros de câncer relacionados ao tabagismo, mais prevalentes entre pessoas do sexo masculino, com mais de 70 anos, nove anos ou mais de escolaridade, cor branca, com companheiro e diagnóstico metastático. Os agrupamentos mais frequentes foram cólon e reto (28,7%), traqueia, brônquios e pulmões (18,6%) e estômago (11,8%). No acompanhamento, 1.450 foram a óbito. O câncer de pâncreas foi o que apresentou pior probabilidade de sobrevivência (14,3%), seguido pelo câncer de fígado (19,4%). CONCLUSÃO Os fatores de risco para o óbito e as taxas de sobrevivência diferem entre os 13 tipos de câncer relacionados ao tabaco. O diagnóstico precoce e a prevenção primária são estratégias que devem ser aprimoradas para melhorar a sobrevivência e diminuir a carga relacionada a esses tipos de câncer.

    Abstract in English:

    ABSTRACT OBJECTIVE To estimate the probability of survival and prognostic factors for tobacco-related neoplasms in a population-based cohort. METHODS This is a cohort with data from the Population-Based Cancer Registry of Florianópolis, southern Brazil, from 2008 to 2012. The Stata 16.0 software was used to estimate the probabilities of survival in five years after diagnosis, by the Kaplan Meier method, and the risk of death, by the Cox regression. RESULTS A total of 2,829 cancer records related to smoking were included, more prevalent among males, over 70 years of age, nine years or more of schooling, white, with a partner and metastatic diagnosis. The most frequent groupings were colon and rectum (28.7%), trachea, bronchi and lungs (18.6%) and stomach (11.8%). At follow-up, 1,450 died. Pancreatic cancer had the worst probability of survival (14.3%), followed by liver cancer (19.4%). CONCLUSION Risk factors for death and survival rates differ across the 13 types of tobacco-related cancers. Early diagnosis and primary prevention are strategies that must be improved to improve survival and decrease the burden related to these types of cancer.
  • Coverage of fluoride data in water supply systems using the R software Original Articles

    Paulino, Camila de Moraes; Belotti, Lorrayne; Azevedo, Moises Kim Zanotto de; Frazão, Paulo

    Abstract in Portuguese:

    RESUMO OBJETIVO Apresentar um protocolo para a crítica dos dados sobre monitoramento do fluoreto na água com recursos de programação do software R, ilustrando sua aplicação para descrever a cobertura dos dados e a qualidade da fluoretação em 2015. MÉTODOS Foi utilizado big data proveniente do Sistema de Informação de Vigilância da Qualidade da Água para Consumo Humano que incluía todos os municípios brasileiros. Os procedimentos de crítica dos dados foram realizados com auxílio do software R. Aplicaram-se filtros para remover municípios com menos de quatro meses de registro (1), e registros com valores nulos (2) e aberrantes (3). Os municípios foram classificados quanto à presença de informações válidas e à qualidade da fluoretação segundo macrorregião, unidades da federação e porte populacional, apresentando-se o script em cada passo. RESULTADOS Foram analisados aproximadamente 134 mil registros. Dos municípios brasileiros, 39% possuíam dados sobre o parâmetro fluoreto e apenas 33,3% apresentaram quatro meses ou mais de frequência de informação. Após a aplicação dos filtros, 1.810 (32,5%) municípios apresentaram informação válida para o parâmetro fluoreto, com substancial variação entre as macrorregiões Sul (83,6%) e Norte (0,7%). Destes, 726 (40,1%) exibiram muito boa qualidade da fluoretação, determinada por 80% ou mais de registros dentro do intervalo concentração ótima para prevenção da cárie dentária, com valor mais alto (54,3%) nos municípios com 50 mil habitantes ou mais e mais baixo (34,2%) naqueles com menos de 10 mil habitantes. CONCLUSÕES Persistem importantes diferenças entre e dentro das macrorregiões brasileiras no que se refere tanto à disponibilidade da informação sobre o parâmetro quanto à qualidade da fluoretação da água nos sistemas de abastecimento público no Brasil. O protocolo para crítica e manuseio dos dados com recursos de programação do software R se mostrou bastante útil para produção de informação voltada a tomada de decisão ancorada em método padronizado.

    Abstract in English:

    ABSTRACT OBJECTIVE To present a protocol to criticize data on fluoride monitoring in water with R software programming features, illustrating its application to describe data coverage, and fluoridation quality in 2015. METHODS The study used big data from the Sistema de Informação de Vigilância da Qualidade da Água para Consumo Humano (Information System for Surveillance of Water Quality for Human Consumption) that included all the Brazilian municipalities. Data criticism procedures were performed with the aid of R software. Filters were applied to remove municipalities with less than four months of records (1), and records with null values (2) and outliers (3). Municipalities were classified regarding the presence of valid information and fluoridation quality according to macro-region, federation units, and population size, presenting the roadmap at each step. RESULTS Approximately 134,000 records were reviewed. Of the Brazilian municipalities, 39% had data on the fluoride parameter, and only 33.3% had four months or more of information frequency. After applying filters, 1,810 (32.5%) municipalities had valid information for the fluoride parameter, with substantial variation between the South (83.6%) and North (0.7%) macro-regions. Of these, 726 (40.1%) showed very good fluoridation quality, determined by 80% or more records within the optimal concentration interval for prevention of dental caries, with higher value (54.3%) in municipalities with 50,000 inhabitants or more, and lower (34.2%) in those with less than 10,000 inhabitants. CONCLUSIONS Important differences persist within and between the Brazilian macro-regions regarding both the availability of information on the parameter, and the quality of water fluoridation in public supply systems in Brazil. The protocol for data review and processing with R software programming resources proved to be very useful for the production of information for decision-making based on a standardized method.
  • Systemic arterial hypertension as a risk factor for the severe form of covid-19: scoping review

    Ribeiro, Ana Cristina; Uehara, Sílvia Carla da Silva André

    Abstract in Portuguese:

    RESUMO OBJETIVO Identificar se a hipertensão arterial sistêmica se apresenta como um fator de risco para o agravamento da covid-19. MÉTODOS Trata-se de uma revisão de escopo, as buscas foram realizadas nas bases de dados Lilacs, PubMed, SciELO e Web of Science. RESULTADOS Foram selecionados 13 artigos. Os estudos apresentaram a hipertensão arterial sistêmica como a doença crônica mais comum em pacientes diagnosticados com covid-19. Os pacientes hipertensos eram mais velhos e os homens se apresentaram mais suscetíveis a desenvolver covid-19 grave. Pacientes hipertensos sem tratamento anti-hipertensivo foram associados a um maior risco de mortalidade. CONCLUSÕES Pacientes com doenças crônicas tendem a apresentar um perfil clínico diferente, sendo essencial controlar a pressão arterial em pacientes hipertensos e monitorá-los continuamente durante a infecção por covid-19.

    Abstract in English:

    ABSTRACT OBJECTIVE Identify whether systemic arterial hypertension is a risk factor for the severe form of covid-19. METHODS This is a scoping review, searches were performed on the Lilacs, PubMed, SciELO and Web of Science databases. RESULTS Thirteen articles were selected. The studies presented systemic arterial hypertension as the most common chronic disease in subjects diagnosed with covid-19. Hypertensive subjects were older, and men were more likely to develop severe covid-19. Hypertensive subjects without antihypertensive treatment were associated with a higher risk of mortality. CONCLUSIONS subjects with chronic diseases tend to have a different clinical profile. Blood pressure should be controlled in hypertensive subjects that should be continuously monitored during the covid-19 infection.
  • Decision aid for prostate cancer screening in Brazil Original Articles

    Santos, Renata Oliveira Maciel dos; Abreu, Mirhelen Mendes de; Migowski, Arn; Engstrom, Elyne Montenegro

    Abstract in Portuguese:

    RESUMO OBJETIVO Apresentar o processo de desenvolvimento e validação de uma ferramenta de apoio à decisão para o rastreamento do câncer de próstata no Brasil. MÉTODOS Estudo com desenho qualitativo-participativo para elaboração de uma ferramenta de apoio à decisão para o rastreamento do câncer de próstata, com a participação de um grupo de homens e médicos inseridos na atenção primária à saúde de 11 estados brasileiros. Realizou-se síntese de evidências, teste de campo e utilização nos cenários clínicos, de modo a adaptar o conteúdo, formato, linguagem e a aplicabilidade às necessidades do público-alvo nos anos de 2018 e 2019. As versões foram avaliadas de forma subsequente pelos participantes, sendo modificada a partir dos dados obtidos. RESULTADOS Foi elaborada uma ferramenta inédita no Brasil, com informações sobre os exames utilizados no rastreamento, comparação dos seus possíveis benefícios e malefícios e um infográfico numérico com as consequências dessa prática. Verificou-se utilidade da ferramenta para auxiliar na comunicação entre o médico e o homem no contexto da atenção primária à saúde, além de identificar a necessidade de maior discussão sobre o compartilhamento das decisões nos cenários clínicos. CONCLUSÃO A ferramenta foi avaliada como de fácil utilização, objetiva e com pouca interferência no tempo de consulta. É um material técnico-científico, produzido por meio de pesquisa, com a participação do seu principal público-alvo e que se encontra disponível gratuitamente para utilização nos cenários clínicos do Brasil.

    Abstract in English:

    ABSTRACT OBJECTIVE To present the development and validation processes of a decision aid for prostate cancer screening in Brazil. METHODS Study with qualitative-participatory design for the elaboration of a decision aid for prostate cancer screening, with the participation of a group of men and physicians inserted in primary health care in 11 Brazilian states. Evidence synthesis, field testing, and use in clinical scenarios were performed to adapt the content, format, language, and applicability towards the needs of the target audience in the years 2018 and 2019. The versions were subsequently evaluated by the participants and modified based on the data obtained. RESULTS We elaborated an unprecedented tool in Brazil, with information about the tests used in the screening, comparison of their possible benefits and harms and a numerical infographic with the consequences of this practice. We verified the decision aid usability to assist in the communication between the doctor and the man in the context of primary health care, besides identifying the need for greater discussion about sharing decisions in clinical scenarios. CONCLUSION The tool was easy to use, objective, and has little interference in consultation time. It is a technical-scientific material, produced by research, with the participation of its main target audience and which is available free of charge for use in Brazilian clinical scenarios.
  • Knowledge, attitudes, and practices of adolescents regarding human papillomavirus Original Articles

    Galvão, Mariana Portela Soares Pires; Araújo, Telma Maria Evangelista de; Rocha, Silvana Santiago da

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar conhecimentos, atitudes e práticas de adolescentes estudantes de escolas públicas do município de Teresina-PI sobre o papilomavírus humano (HPV). MÉTODOS Estudo transversal, analítico, realizado em 12 escolas da rede pública do município de Teresina, com uma amostra aleatória de 472 adolescentes de 15 anos. Todos os participantes responderam a um questionário validado, que avaliou as características sociodemográficas, o nível de conhecimento sobre o HPV, atitudes relacionadas à vacinação e ao status vacinal. Os níveis de conhecimento e atitude foram classificados por meio de escores padronizados e a prática mediante a situação vacinal. As análises foram realizadas com o uso do SPSS. Na análise bivariada, utilizou-se a regressão logística simples, por meio de odds ratio para identificar as associações entre as características sociodemográficas e o conhecimento, e a atitude com a prática de prevenção contra o HPV. As variáveis que na análise bivariada apresentaram valor de p ≤ 0,20 foram submetidas ao modelo multivariado de regressão logística. A significância estatística foi fixada em p < 0,05. RESULTADOS Dentre os participantes, 27,3% apresentaram conhecimento suficiente, 34,1% atitudes positivas e 74,6% prática adequada. Na análise multivariada observou-se associação estatisticamente significativa entre o sexo feminino (ORa = 15,62; IC95%: 9,08–26,9), conhecimento satisfatório (ORa = 2,09; IC95%: 1,15–3,81), e atitudes positivas (ORa = 1,89; IC95%: 1,10–3,23) com a prática adequada. CONCLUSÕES Ser do sexo feminino, ter nível de conhecimento sobre o HPV e a vacina classificados como satisfatório, bem como ter atitudes positivas frente à vacinação contra o HPV reforçam a prática adequada de vacinação. Estes achados demonstram a necessidade de ampliar o conhecimento dos adolescentes, gerando atitudes positivas com vistas à vacinação dentro de uma perspectiva adequada.

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze knowledge, attitudes, and practices of adolescent students from public schools in the municipality of Teresina, state of Piauí, regarding human papillomavirus (HPV). METHODS Cross-sectional, analytical study carried out in 12 public schools in the municipality of Teresina, with a random sample of 472 15-year-old adolescents. All participants answered a validated questionnaire, which evaluated sociodemographic characteristics, level of knowledge about HPV, attitudes regarding vaccination and vaccination status. The levels of knowledge and attitude were classified by standardized scores and practice by the vaccination situation. The analyses were carried out using the SPSS software. In the bivariate analysis, simple logistic regression was used generating odds ratios to identify the associations of sociodemographic characteristics, knowledge, and attitude with HPV prevention practice. Variables that presented p-value ≤ 0.20 in the bivariate analysis were inserted in a multivariate logistic regression model. Statistical significance was set at p < 0.05. RESULTS Among the participants, 27.3% had sufficient knowledge, 34.1% had positive attitudes, and 74.6% had adequate practice. In the multivariate analysis, we observed a statistically significant association among females (ORa = 15.62; 95%CI: 9.08–26.9), satisfactory knowledge (ORa = 2.09; 95%CI: 1.15–3.81), and positive attitudes (ORa = 1.89; 95%CI: 1.10–3.23) with proper practice. CONCLUSIONS Being female, having a satisfactory level of knowledge about HPV and the vaccine, and having positive attitudes towards HPV vaccination reinforce the appropriate practice of vaccination. These findings demonstrate the need to expand the knowledge of adolescents, generating positive attitudes towards vaccination within an appropriate perspective.
  • Management in the care of people with HIV in primary health care in times of the new coronavirus Original Articles

    Celuppi, Ianka Cristina; Meirelles, Betina Hörner Schlindwein; Lanzoni, Gabriela Marcellino de Melo; Geremia, Daniela Savi; Metelski, Fernanda Karla

    Abstract in Portuguese:

    RESUMO OBJETIVO Compreender as práticas de gestão no cuidado às pessoas que vivem com o vírus da imunodeficiência humana (HIV) na Atenção Primária à Saúde de uma capital brasileira, em tempos de pandemia do novo coronavírus (covid-19). MÉTODO Trata-se de uma pesquisa qualitativa, ancorada no referencial metodológico-analítico da teoria fundamentada nos dados, vertente construtivista. Os dados foram coletados por entrevistas intensivas online, com enfermeiros de centros de saúde e gestores da secretaria municipal. A coleta e análise dos dados ocorreram de maneira concomitante, em duas fases de análise: a codificação inicial e focalizada. RESULTADOS Apontam para o desenvolvimento das melhores práticas de cuidado, com destaque para iniciativas de coordenação do cuidado, descentralização do manejo clínico para os serviços de APS, instituição de protocolos e fluxos, pactuação de parcerias intersetoriais, utilização de grupos e redes sociais, uso de ferramentas como a teleconsulta e planilha de vigilância em saúde e formação de redes de apoio. CONCLUSÃO A capital brasileira reestruturou sua rede de serviços de saúde com a implementação de protocolos clínicos e gerenciais, buscando manter a continuidade do cuidado às pessoas que vivem com o HIV. Destacou-se a incorporação de tecnologias de cuidado não presencial e a facilitação de rotinas, como estratégias para ampliação do acesso.

    Abstract in English:

    ABSTRACT OBJECTIVE To understand management practices in the care of people living with the human immunodeficiency virus (HIV) in primary health care in a Brazilian capital, in times of the new coronavirus (covid-19) pandemic. METHOD Qualitative research, anchored in the methodological-analytical framework of the grounded theory, constructivist aspect. Data were collected by using intensive online interviews with nurses from health centers and managers of the municipal health department. Data collection and analysis occurred concomitantly in two phases of analysis: initial and focused coding. RESULTS They point to the development of best care practices, with emphasis on initiatives for coordination of care, decentralization of clinical management for primary health care services, establishment of protocols and flows, agreement of intersectoral partnerships, use of groups and social networks, use of tools such as teleconsultation and health surveillance spreadsheet and formation of support networks. CONCLUSION The Brazilian capital restructured its network of health services with the implementation of clinical and management protocols, seeking to maintain care for people living with HIV. We highlighted the incorporation of non-face-to-face care technologies and the facilitation of routines, as strategies for expanding access.
  • Spatial correlation of covid-19 with intensive care unit beds in Paraná Original Articles

    Covre, Eduardo Rocha; Pereira, Natan David; Oliveira, Natan Nascimento de; Charlo, Patrícia Bossolani; Oliveira, Magda Lúcia Félix de; Oliveira, Rosana Rosseto de; Carreira, Lígia; Facchini, Luiz Augusto; Vissoci, João Ricardo Nickenig; Salci, Maria Aparecida

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar a correlação espacial entre os casos confirmados de covid-19 com os leitos de unidades de terapia intensiva exclusivos para a doença nos municípios do Paraná. MÉTODO Trata-se de um estudo epidemiológico, do tipo ecológico que utilizou dados do Informe Epidemiológico fornecido pela Secretaria de Estado da Saúde do Paraná sobre os casos confirmados de covid-19, no período de 12 de março de 2020 a 18 de janeiro de 2021. A quantidade de leitos de terapia intensiva exclusivos para covid-19 de cada município paranaense foi obtida pelo Cadastro Nacional de Estabelecimentos de Saúde disponibilizado online pelo Departamento de Informática do Sistema Único de Saúde. A variável leito de terapia intensiva foi analisada pelo Índice Bivariado de Moran (local e global). Para a identificação de áreas críticas e de transição utilizou-se o LISA Map. Para avaliar a correlação espacial foi utilizado o Índice Bivariado de Moran, considerando o nível de significância de 5%. RESULTADOS No período analisado foram confirmados 499.777 casos de covid-19 no Paraná e identificados 1.029 leitos de terapia intensiva exclusivos para a doença entre os municípios do estado. Foi identificado autocorrelação espacial positiva entre os casos confirmados de covid-19 (0,404–p ≤ 0,001) com os leitos de terapia intensiva exclusivos para a doença (0,085–p ≤ 0,001) e disparidades entre as regiões do Paraná. CONCLUSÃO A análise espacial permitiu confirmar a relação entre os casos confirmados de covid-19 e a distribuição de leitos de terapia intensiva exclusivos para a doença no Paraná e possibilitou identificar áreas prioritárias de atenção no estado, relacionadas à disseminação e controle da doença.

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze the spatial correlation between confirmed cases of covid-19 and the intensive care unit beds exclusive to the disease in municipalities of Paraná. METHODS This is an epidemiological study of ecological type which used data from the Epidemiological Report provided by the Department of Health of Paraná on the confirmed cases of covid-19 from March 12, 2020, to January 18, 2021. The number of intensive care beds exclusive to covid-19 in each municipality of Paraná was obtained by the Cadastro Nacional de Estabelecimentos de Saúde (CNES - National Registry of Health Establishments), provided online by the Departamento de Informática do Sistema Único de Saúde (Datasus - Informatics Department of the Brazilian Unified Health System). The Bivariate Moran’s Index (local and global) was used to analyze the intensive care bed variable and spatial correlation, with a 5% significance level. LISA Map was used to identify critical and transition areas. RESULTS In the analyzed period, we found 499,777 confirmed cases of covid-19 and 1,029 intensive care beds exclusive to the disease in Paraná. We identified a positive spatial autocorrelation between the confirmed cases of covid-19 (0.404–p ≤ 0.001) and intensive care beds exclusive to the disease (0.085–p ≤ 0.001) and disparities between the regions of Paraná. CONCLUSION Spatial analysis indicated that confirmed cases of covid-19 are related to the distribution of intensive care beds exclusive to the disease in Paraná, allowing us to find priority areas of care in the state regarding the dissemination and control of the disease.
  • Vulnerabilities of Arab refugees in primary health care: a scoping review

    Lima Junior, Luiz Paulo de; Lima, Kayte Chaves Oliveira de; Bertolozzi, Maria Rita; França, Francisco Oscar de Siqueira

    Abstract in Portuguese:

    RESUMO OBJETIVO Mapear e analisar as vulnerabilidades de refugiados árabes no contexto da atenção primária à saúde. MÉTODO Revisão de escopo em que foram analisados estudos publicados nos idiomas inglês, espanhol e português, a partir de 2011. As bases foram Cochrane, Scopus, Health System Evidence , MedLine-PubMed, CINAHL, Embase, Lilacs, Web of Science , SciELO, NYAM Grey Literature , BVS, Banco de teses e dissertações Capes, Refworld e Journal of Refugee Studies. A análise dos dados foi realizada à luz do conceito de vulnerabilidade. RESULTADOS Dos 854 estudos identificados, restaram 40 artigos para análise e extração dos indicadores de vulnerabilidade nas dimensões individual, social e programática. Em relação à dimensão individual, os principais indicadores identificados foram desemprego, moradias instáveis e superlotadas, falta de saneamento e de acesso à água, agravos mentais, doenças transmissíveis e crônicas não transmissíveis etc. Na dimensão programática foram identificadas, principalmente, equipes de saúde com sobrecarga de trabalho, falta de preparo para lidar com as barreiras culturais e linguísticas, demora para o atendimento. Em relação à dimensão social, constatou-se falta de acesso às escolas, à informação sobre os programas de saúde dos países de acolhida, aos direitos, entre outros. CONCLUSÃO As vulnerabilidades constatadas evidenciam desvantagem dos refugiados perante os programas, serviços e sistema de saúde nos países de acolhida, além de colocar em evidência as profundas desigualdades que incidem nesse grupo. Aponta-se a necessidade de programas e políticas que promovam ações, no âmbito da atenção primária à saúde, que reconheçam e respondam às necessidades de saúde de refugiados.

    Abstract in English:

    ABSTRACT OBJECTIVE To map and analyze the vulnerabilities of Arab refugees in the context of primary health care. METHOD Scoping review in which studies published in English, Spanish and Portuguese languages from 2011 onwards were reviewed. The following databases were surveyed: Cochrane, Scopus, Health System Evidence, MedLine-PubMed, CINAHL, Embase, Lilacs, Web of Science, SciELO, NYAM Grey Literature, BVS, Capes Thesis and Dissertation Database, Refworld and Journal of Refugee Studies. Data were analyzed in light of the concept of vulnerability. RESULTS Of the 854 studies identified, 40 articles were held for analysis and extraction of vulnerability indicators in the individual, social and programmatic dimensions. Regarding the individual dimension, the main indicators identified were unemployment, unstable and overcrowded housing, lack of sanitation and access to water, mental disorders, communicable and chronic noncommunicable diseases, etc. In the programmatic dimension, were identified, mainly, health teams with work overload, lack of preparation to deal with cultural and linguistic barriers, and delays in providing care. In relation to the social dimension, lack of access to schools, to information about health programs in the host countries, and to rights, among others, were found. CONCLUSION Vulnerabilities found highlight the disadvantage of refugees regarding health programs, services and system in host countries, in addition to highlighting the deep inequalities that affect this group. It is pointed out the need for programs and policies that promote actions, within the scope of primary health care, which recognize and respond to the health needs of refugees.
  • Covid-19 vaccination priorities defined on machine learning Original Articles

    Couto, Renato Camargos; Pedrosa, Tania Moreira Grillo; Seara, Luciana Moreira; Couto, Carolina Seara; Couto, Vitor Seara; Giacomin, Karla; Abreu, Ana Claudia Couto de

    Abstract in English:

    ABSTRACT OBJECTIVE Defining priority vaccination groups is a critical factor to reduce mortality rates. METHODS We sought to identify priority population groups for covid-19 vaccination, based on in-hospital risk of death, by using Extreme Gradient Boosting Machine Learning (ML) algorithm. We performed a retrospective cohort study comprising 49,197 patients (18 years or older), with RT-PCR-confirmed for covid-19, who were hospitalized in any of the 336 Brazilian hospitals considered in this study, from March 19th, 2020, to March 22nd, 2021. Independent variables encompassed age, sex, and chronic health conditions grouped into 179 large categories. Primary outcome was hospital discharge or in-hospital death. Priority population groups for vaccination were formed based on the different levels of in-hospital risk of death due to covid-19, from the ML model developed by taking into consideration the independent variables. All analysis were carried out in Python programming language (version 3.7) and R programming language (version 4.05). RESULTS Patients’ mean age was of 60.5 ± 16.8 years (mean ± SD), mean in-hospital mortality rate was 17.9%, and the mean number of comorbidities per patient was 1.97 ± 1.85 (mean ± SD). The predictive model of in-hospital death presented area under the Receiver Operating Characteristic Curve (AUC - ROC) equal to 0.80. The investigated population was grouped into eleven (11) different risk categories, based on the variables chosen by the ML model developed in this study. CONCLUSIONS The use of ML for defining population priorities groups for vaccination, based on risk of in-hospital death, can be easily applied by health system managers
  • Fluoride toothpaste, sanitary surveillance and the SUS: the case of Manaus-AM, Brazil Original Articles

    Ramos, Mayara Costa Carneiro; Rebelo, Maria Augusta Bessa; Rebelo Vieira, Janete Maria; Miranda, Luís Fernando Bandeira; Tabchoury, Cinthia Pereira Machado; Cury, Jaime Aparecido

    Abstract in Portuguese:

    RESUMO OBJETIVO Determinar o potencial anticárie dos dentifrícios distribuídos pelas unidades básicas de saúde (UBS) de Manaus-AM. MÉTODOS Noventa e nove bisnagas de dentifrícios de quatro marcas comerciais foram coletadas de 7 de outubro de 2019 a 11 de outubro de 2019 em 16 UBS, que foram codificados por marca e UBS de origem. De acordo com a embalagem, os dentifrícios das quatro marcas e seus lotes foram formulados com monofluorofosfato de sódio (Na2FPO3) e a maioria (91%) tinha carbonato de cálcio (CaCO3) como abrasivo. Foram determinadas as concentrações de fluoreto total (FT = FST + Fins) e de fluoreto solúvel total (FST = íons F- ou FPO32-), para certificar se atendiam à resolução ANVISA RDC Nº 530 (máximo de 1.500 ppm de FT) e se tinham potencial anticárie (mínimo de 1.000 ppm de FST). As análises foram feitas com eletrodo íon específico. RESULTADOS As concentrações (ppm F) de FT [média; desvio padrão (DP); n] encontradas nos dentifrícios A (1.502,3; DP = 45,6; n = 33), B (1.135,5; DP = 52,7; n = 48) e D (936,8; DP = 20,5; n = 8) foram próximas ao descrito na embalagem, 1.500, 1.100 e 1.000 ppm F, respectivamente. No dentifrício C, foi encontrada média de 274,1 ppm (DP = 219,7; n = 10) de FT, divergindo da concentração declarada de 1.500 ppm F. Em acréscimo, as cinco bisnagas do lote no 11681118 do dentifrício C não foram fluoretadas. Quanto ao FST, à exceção do dentifrício D (937,9; DP = 40,29), os demais apresentaram concentração inferior ao seu respectivo FT. CONCLUSÃO Observou-se problemas graves de quantidade e qualidade do fluoreto nos dentifrícios distribuídos pelo SUS em Manaus, mostrando a necessidade de vigilância desses produtos e ratificando a urgência da revisão da resolução ANVISA RDC Nº 530.

    Abstract in English:

    ABSTRACT OBJECTIVE To determine the anticaries potential of toothpastes distributed by the primary health care public clinics (UBS) of Manaus, AM. METHODS Ninety-nine tubes of toothpaste from four commercial brands were collected from October 7, 2019 to October 11, 2019 in 16 UBS. They were assigned a code by brand and source UBS. According to the information on the packaging, the four brands and their batches were formulated with sodium monofluorophosphate (Na2FPO3) and most (91%) had calcium carbonate (CaCO3) as an abrasive. We determined the concentrations of total fluoride (TF = TSF + InsF) and total soluble fluoride (TSF = F ions- or FPO32-), to certify whether they were in compliance with resolution ANVISA RDC No. 530 (maximum of 1,500 ppm TF) and whether they had anticaries potential (minimum of 1,000 ppm TSF). The analyses were performed with a ion- specific electrode. RESULTS The concentrations (ppm F) of TF [mean; standard deviation (SD); n] found in toothpaste brands A (1,502.3; SD = 45.6; n = 33), B (1,135.5; SD = 52.7; n = 48) and D (936.8; SD = 20.5; N = 8) were close to those stated on the package, 1,500, 1,100 and 1,000 ppm F, respectively. In toothpaste C, we found a mean of 274.1 ppm (SD = 219.7; n = 10) of TF, which diverges from the declared concentration of 1,500 ppm F. In addition, the five tubes of lot no. 11681118 of toothpaste C did not contain fluoride. Regarding TSF, with the exception of toothpaste D (937.9; SD = 40.29), the others had a lower concentration than their respective TF. CONCLUSION We found serious problems of quantity and quality of fluoride in toothpaste distributed by the SUS in Manaus, which shows the need for surveillance of these products and confirms the urgency of revising resolution RDC No. 530.
  • Benzodiazepines utilization in Brazilian older adults: a population-based study Original Articles

    Freire, Marina de Borba Oliveira; Da Silva, Bruna Gonçalves Cordeiro; Bertoldi, Andréa Dâmaso; Fontanella, Andréia Turmina; Mengue, Sotero Serrate; Ramos, Luiz Roberto; Tavares, Noemia Urruth Leão; Pizzol, Tatiane da Silva Dal; Arrais, Paulo Sérgio Dourado; Farias, Mareni Rocha; Luiza, Vera Lucia; Oliveira, Maria Auxiliadora; Menezes, Ana Maria Baptista

    Abstract in Portuguese:

    RESUMO OBJETIVO Avaliar a utilização de benzodiazepínicos (BZD) em idosos brasileiros,a partir de dados da Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM). MÉTODOS A PNAUM é um estudo transversal, conduzido entre 2013 e 2014, com representatividade da população urbana brasileira. No presente estudo, foram incluídos indivíduos com 60 anos ou mais (n = 9.019). Foi calculada a prevalência de utilização de BZD nos 15 dias anteriores à coleta dos dados da pesquisa, geral e segundo as variáveis independentes, por meio de análise bruta e ajustada, utilizando modelo hierárquico de regressão de Poisson. A coleta de dados foi realizada por meio de entrevista domiciliar. RESULTADOS A prevalência de utilização de BZD em idosos foi de 9,3% (IC95%: 8,3–10,4). Após análise ajustada, foram associados à maior utilização de BZD: sexo feminino (RP = 1,88; IC95%: 1,52–2,32), depressão (RP = 5,31; IC95%: 4,41–6,38), multimorbidade (RP = 1,44; IC95%: 1,20–1,73), visita à emergência ou internação hospitalar nos últimos 12 meses (RP = 1,42; IC95%: 1,18–1,70), polifarmácia (RP = 1,26; IC95%: 1,01–1,57) e autopercepção de saúde ruim ou muito ruim (RP = 4,16; IC95%: 2,10–8,22). A utilização foi menor na região Norte (RP = 0,18; IC95%: 0,13–0,27) e em indivíduos que relataram consumo abusivo de álcool no último mês (RP = 0,42; IC95%: 0,19–0,94). CONCLUSÃO Apesar das recomendações contrárias ao uso, os resultados demonstraram elevada prevalência de utilização de BZD em idosos, particularmente naqueles que apresentam depressão, além de amplas diferenças em relação às regiões do país e ao sexo do indivíduo.

    Abstract in English:

    ABSTRACT OBJECTIVE To evaluate the utilization of benzodiazepines (BZD) in Brazilian older adults, based on the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey of Access, Use and Promotion of Rational Use of Medicines). METHODS The PNAUM is a cross-sectional study conducted between 2013 and 2014, representing the Brazilian urban population. In the present study, we included 60 years or older (n = 9,019) individuals. We calculated the prevalence of BZD utilization in the 15 days prior to survey data collection according to independent variables, using a hierarchical Poisson regression model. A semistructured interview performed empirical data collection (household interview). RESULTS The prevalence of BZD utilization in the older adults was 9.3% (95%CI: 8.3–10.4). After adjustments, BZD utilization was associated with female sex (PR = 1.88; 95%CI: 1.52–2.32), depression (PR = 5.31; 95%CI: 4.41–6, 38), multimorbidity (PR = 1.44; 95%CI: 1.20–1.73), emergency room visit or hospitalization in the last 12 months (PR = 1.42; 95%CI: 1.18–1.70 ), polypharmacy (PR = 1.26; 95%CI: 1.01–1.57) and poor or very poor self-rated health (PR = 4.16; 95%CI: 2.10–8.22). Utilization was lower in the North region (PR = 0.18; 95%CI: 0.13–0.27) and in individuals who reported abusive alcohol consumption in the last month (PR = 0.42; 95%CI: 0.19–0.94). CONCLUSION Despite contraindications, results showed a high prevalence of BZD utilization in older adults, particularly in those with depression, and wide regional and sex differences.
  • Mental health of nursing professionals during the COVID-19 pandemic: a cross-sectional study Original Articles

    Oliveira, Michele Mandagará de; Treichel, Carlos Alberto dos Santos; Bakolis, Ioannis; Alves, Poliana Farias; Coimbra, Valéria Cristina Christello; Cavada, Gustavo Pachon; Sperb, Lilian Cruz Souto de Oliveira; Guedes, Ariane da Cruz; Antonacci, Milena Hohmann; Willrich, Janaína Quinzen

    Abstract in English:

    ABSTRACT OBJECTIVE To identify the prevalence of and factors associated with: (1) major depressive episodes; (2) minor psychiatric disorders (MPDs); and (3) suicidal ideation among nursing professionals from a municipality in southern Brazil. METHODS Using a cross-sectional design, we recruited 890 nursing professionals linked to 50 Primary Care units, 2 walk-in clinics, 2 hospital services, 1 emergency room service, 1 mobile emergency care service, and 1 teleconsultation service, in addition to the municipal epidemiological surveillance service and the vacancy regulation center between June and July 2020. We used the Patient Health Questionnaire-9 and the Self-Reporting Questionnaire to evaluate the studied outcomes. Associations between the outcomes and variables related to sociodemographic profile, work, health conditions, and daily life were explored using Poisson regression models with robust variance estimators. RESULTS The observed prevalence of depression, MPDs, and suicidal ideation were 36.6%, 44%, and 7.4%, respectively. MPDs were associated with the assessment of support received by the service as ‘regular’ (PR: 1.48; 95% CI: 1.19–1.85) or ‘poor’ (PR: 1.54; 95% CI: 1.23–1.94), with a reported moderate (PR: 1.63; 95% CI: 1.29–2.07), or heavy (PR: 2.54; 95% CI: 2.05–3.15) workload, and with suspected COVID-19 infection (PR: 1.44; 95% CI: 1.25–1.66). Major depressive episodes were associated with a reported lack of personal protective equipment (PR: 1.20; 95% CI: 1.01–1.42), whereas suicidal ideation was inversely related to per capita income > 3 minimum monthly wages (PR: 0.28; 95% CI: 0.11–0.68), and positively related to the use of psychotropic drugs (PR: 3.14; 95% CI: 1.87–5.26). CONCLUSION Our results suggest that nursing professionals’ working conditions are associated with their mental health status. The need to improve working conditions through adequate dimensioning, support and proper biosafety measures is only heightened in the context of the COVID-19 pandemic.
  • Recurrent preterm birth: data from the study “Birth in Brazil” Original Articles

    Dias, Barbara Almeida Soares; Leal, Maria do Carmo; Martinelli, Katrini Guidolini; Nakamura-Pereira, Marcos; Esteves-Pereira, Ana Paula; Santos Neto, Edson Theodoro dos

    Abstract in Portuguese:

    RESUMO OBJETIVO Descrever e estimar a taxa de prematuridade recorrente no Brasil segundo o tipo de parto, ponderado pelos fatores associados. MÉTODOS Os dados foram obtidos do estudo nacional de base hospitalar “Nascer no Brasil”, realizado em 2011 e 2012, a partir de entrevistas com 23.894 mulheres. Inicialmente foi utilizado o teste qui-quadrado para verificar as diferenças entre os recém-nascidos, segundo a prematuridade prévia e o tipo de prematuridade recorrente. Sequencialmente, aplicou-se o método de ponderação pelo escore de propensão para equilibrar os grupos de acordo com as seguintes covariáveis: idade materna, classificação socioeconômica, tabagismo durante a gravidez, paridade, cesárea anterior, natimorto ou óbito neonatal anterior, hipertensão crônica e diabetes crônica. Por último, foi realizada regressão logística múltipla para estimar a prematuridade recorrente. RESULTADOS Foram analisados 6.701 recém-nascidos. A taxa de prematuridade recorrente foi de 42,0%, considerando todas as mulheres com prematuridade prévia. Dentre os prematuros recorrentes, 62,2% foram espontâneos e 37,8% ocorreram por intervenção-obstétrica. Após a ponderação pelo escore de propensão, verificou-se que mulheres com prematuridade prévia têm 3,89 vezes a chance de terem prematuridade recorrente espontânea (ORaj = 3,89; IC95% 3,01–5,03) e 3,47 vezes a chance de terem prematuridade recorrente por intervenção obstétrica (ORaj = 3,47; IC95% 2,59–4,66), em comparação às mulheres que tiveram recém-nascidos termo completo. CONCLUSÕES A prematuridade prévia revelou-se um forte preditor para sua recorrência. Assim, ampliar e melhorar o monitoramento e manejo de gestantes com história de prematuridade impacta fortemente na redução das taxas e, consequentemente, na redução dos riscos de morbimortalidade infantil no país.

    Abstract in English:

    ABSTRACT OBJECTIVE Describe and estimate the rate of recurrent preterm birth in Brazil according to the type of delivery, weighted by associated factors. METHODS We obtained data from the national hospital-based study “Birth in Brazil”, conducted in 2011 and 2012, from interviews with 23,894 women. Initially, we used the chi-square test to verify the differences between newborns according to previous prematurity and type of recurrent prematurity. Sequentially, we applied the propensity score method to balance the groups according to the following covariates: maternal age, socio-economic status, smoking during pregnancy, parity, previous cesarean section, previous stillbirth or neonatal death, chronic hypertension and chronic diabetes. Finally, we performed multiple logistic regression to estimate the recorrence. RESULTS We analyzed 6,701 newborns. The rate of recurrence was 42.0%, considering all women with previous prematurity. Among the recurrent premature births, 62.2% were spontaneous and 37.8% were provider-initiated. After weighting by propensity score, we found that women with prematurity have 3.89 times the chance of having spontaneous recurrent preterm birth (ORaj = 3.89; 95%CI 3.01–5.03) and 3.47 times the chance of having provider-initiated recurrent preterm birth (ORaj = 3.47; 95%CI 2.59–4.66), compared to women who had full-term newborns. CONCLUSIONS Previous prematurity showed to be a strong predictor for its recurrence. Thus, expanding and improving the monitoring and management of pregnant women who had occurrence of prematurity strongly influence the reduction of rates and, consequently, the reduction of infant morbidity and mortality risks in the country.
  • Women engaged in prostitution and COVID-19: why are they excluded from socially vulnerable groups? Brief Communication

    Chiang, Michelle Ishida; Basile, Maitê Leite; Souza, Ana Beatriz Pereira de; Moccagatta, Isabella Dastler; Vieira, Julia Rabello Guerra; Lourenço, Thaís Rocha; Gonçalves, Mariana Langanke; Pinto, Helena Afférri Fernandes; Lowenthal, Rosane; Ferrer, Michele Lacerda Pereira; Klautau, Giselle Burlamaqui

    Abstract in Portuguese:

    RESUMO Esta pesquisa analisou a exposição de mulheres em situação de prostituição no centro de São Paulo à covid-19. Este estudo transversal contou com amostra de conveniência selecionada em maio de 2021. Entrevistou-se 219 mulheres majoritariamente negras, de meia idade, pobres e com comorbidades. Dentre essas mulheres, 61 tiveram sintomas de covid-19, 23 com teste positivo,7 foram internadas e 4 relataram complicações pós-covid-19. Somente 26 (30,2%) haviam sido vacinadas. Além das desigualdades de gênero, raça e classe, essas mulheres são expostas a um maior risco de contraírem covid-19, devido às condições de trabalho e por apresentarem doença grave relacionada à idade e falta de vacinação.

    Abstract in English:

    ABSTRACT This study analyzed the exposure of women engaged in prostitution in downtown São Paulo to COVID-19. This cross-sectional study had a convenience sample selected in May 2021. We interviewed 219, mostly black, middle-aged, poor women with comorbidities. Among them, 61 had shown COVID-19 symptoms, 23, tested positive for the disease, seven underwent hospitalization, and four reported post-COVID-19 complications. Only 26 (30.2%) had been vaccinated. In addition to gender, race, and class inequalities, these women suffer both from a higher risk of contracting COVID-19 due to their working conditions and from the subsequent worsening of that disease due to age and lack of vaccination.
  • Implementation of the e-SUS Primary Care Strategy: an analysis based on official data Original Articles

    Cielo, Ana Claudia; Raiol, Tainá; Silva, Everton Nunes da; Barreto, Jorge Otávio Maia

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar a implantação da estratégia e-SUS Atenção Básica (e-SUS AB) no Brasil entre os anos iniciais do sistema, de 2013 até 2019. MÉTODOS Trata-se de um estudo quantitativo, descritivo e exploratório. Foram considerados os dados oficiais do Ministério da Saúde, enviados pelos municípios brasileiros, no período de abril de 2013 a dezembro de 2019. Os municípios foram categorizados como ‘não implantado’, ‘implantação inicial’, ‘implantação parcial’ e ‘implantado’, de acordo com os critérios definidos neste estudo. Verificou-se também se o tipo de município, segundo a classificação do IBGE, influenciou no grau de implantação da estratégia e-SUS AB. Foram realizadas análises descritivas e investigada a associação entre os graus de implantação do e-SUS AB e a tipologia da classificação e caracterização dos espaços rurais e urbanos do IBGE. RESULTADOS O grau de implantação aumentou no período analisado. A situação de implantação da estratégia e-SUS AB, em 2019, foi ‘implantado’ em 20,2% (1.117) dos municípios, ‘implantação parcial’ em 32,9% (1.819), ‘implantação inicial’ 39,1% (2.159) e a situação ‘não implantado’ foi atribuída em 7,8% (432). As regiões Sul e Sudeste apresentaram a melhor situação de implantação em todos os anos e os estados do Rio Grande do Sul, São Paulo e Santa Catarina alcançaram um maior percentual de municípios com a situação ‘implantado’ em 2019. CONCLUSÕES Houve avanço na implantação da estratégia e-SUS AB ao longo dos anos. A maior parte dos municípios encontra-se entre o status ‘implantação inicial’ e ‘implantação parcial’. Com isso, conclui-se que ainda são necessários investimentos em recursos tecnológicos, treinamento de profissionais e suporte para qualificar a implantação e uso de sistemas de informação no país, especialmente para a estratégia e-SUS AB.

    Abstract in English:

    ABSTRACT OBJETIVE Analyze the implementation of the strategy e-SUS Atenção Básica (e-SUS AB – e-SUS Primary Care) in Brazil between the first years of the system, from 2013 to 2019. METHODS This is a quantitative, descriptive, and exploratory study. We considered official data from the Ministry of Health, submitted by Brazilian municipalities, in the period from April 2013 to December 2019. We categorized the municipalities as ‘not implemented’, ‘initial implementation’, ‘partial implementation’ and ‘implemented’ according to the criteria defined in this study. We also verified whether the type of municipality, according to the IBGE classification, influenced the degree of implementation of the e-SUS AB strategy. We performed descriptive analyses and investigated the association between the degrees of implementation of e-SUS AB and the typology of the IBGE classification and characterization of rural and urban spaces. RESULTS The implementation increased in the analyzed period. The implementation status of the e-SUS AB strategy in 2019 was ‘implemented’ in 20.2% (1,117) of the municipalities, ‘partial implementation’ in 32.9% (1,819), ‘initial implementation’ in 39.1% (2,159) and ‘not implemented’ in 7.8% (432). The South and Southeast regions presented the best implementation situation in all years, and the states of Rio Grande do Sul, São Paulo and Santa Catarina reached a higher percentage of municipalities with ‘implemented’ status in 2019. CONCLUSIONS We confirmed the progress in the implementation of the e-SUS AB strategy over the years. Most of the municipalities are between the status ‘initial implementation’ and ‘partial implementation’. Therefore, we conclude that investments in technological resources, training of professionals, and support are necessary to qualify the implementation and use of information systems in the country, especially for the e-SUS AB strategy.
  • Ultra-processed food intake and diet carbon and water footprints: a national study in Brazil Original Articles

    Garzillo, Josefa Maria Fellegger; Poli, Vanessa Fadanelli Schoenardie; Leite, Fernanda Helena Marrocos; Steele, Euridice Martinez; Machado, Priscila Pereira; Louzada, Maria Laura da Costa; Levy, Renata Bertazzi; Monteiro, Carlos Augusto

    Abstract in English:

    ABSTRACT OBJECTIVE To study the association between ultra-processed food consumption and carbon and water footprints of the Brazilian diet. METHODS Cross-sectional analysis on data collected in 2008–2009 on a probabilistic sample of the Brazilian population aged ≥ 10 years (n = 32,886). Individual food intake was assessed using two 24-hour food records, on non-consecutive days. The environmental impact of individual diets was calculated by multiplying the amount of each food by coefficients that quantify the atmospheric emissions of greenhouse gases in grams of carbon dioxide equivalent (carbon footprint) and freshwater use in liters (water footprint), both per gram or milliliter of food. The two coefficients consider the food life cycle ‘from farm to fork.’ Crude and adjusted linear regression models and tests for linear trends assessed the association between the ultra-processed food contribution to total energy intake (quintiles) and the diet carbon and water footprints. Potential confounders included age, sex, education, income, and region. Total energy intake was assessed as a potential mediation variable. RESULTS In the crude models, the dietary contribution of ultra-processed foods was linearly associated with the carbon and water footprints of the Brazilian diet. After adjustment for potential confounders, the association remained significant only regarding the diet water footprint, which increased by 10.1% between the lowest and highest quintile of the contribution of ultra-processed foods. Additional adjustment for total energy intake eliminated this association indicating that the dietary contribution of ultra-processed foods increases the diet water footprint by increasing energy intake. CONCLUSIONS The negative impact of ultra-processed foods on the diet water footprint, shown for the first time in this study, adds to the negative impacts of these foods, already demonstrated regarding dietary nutrient profiles and the risk for several chronic non-communicable diseases. This reinforces the recommendation to avoid ultra-processed foods made in the official Brazilian Dietary Guidelines and increasingly in dietary guidelines of other countries.
  • Obesity and COVID-19 in-hospital fatality in southern Brazil: impact by age and skin color Original Articles

    Houvèssou, Gbènankpon Mathias; Leventhal, Daniel G P; Silva, Eduardo Viegas da

    Abstract in English:

    ABSTRACT OBJECTIVES To estimate the relative risk (RR) of death associated with obesity, the attributable fraction in the exposed/with obesity (AFo), and the hospitalized population attributable risk (hospitalized PAR) associated with obesity of death among all adults and among Black and non-Black adults hospitalized for severe COVID-19 in the state of Rio Grande do Sul, Brazil. METHODS This retrospective cohort study of prognostic factors analyzed all cases of adults hospitalized for severe COVID-19 in the state of Rio Grande do Sul, Brazil. The occurrence of obesity was measured using secondary data from hospital teams’ surveillance records. The outcome assessed was hospital deaths caused by severe COVID-19. Poisson regression was used to estimate RRs and 95% confidence intervals (95%CI). RESULTS The study sample consisted of 100,099 patients hospitalized for severe COVID-19, most of whom were White (84.7%) and male (54.7%). The effect of obesity was strongly modified by age, being higher in younger age groups. For the 18–39-year-old age group, RR = 2.54 (95%CI: 2.33–2.77), and in individuals 70 years and above, RR = 1.09 (95%CI: 1.05–1.13). For the 18–39-year-old age range, AFo = 60.6% and AFo = 42.5% in individuals 40–59 years old. For all hospitalizations, Hospitalized PAR measuring obesity for individuals 18–39 years old was 25.3%, while in the 40–59-year-old range, the hospitalized PAR = 11.2%. The hospitalized PAR was 31.7% in the Black population aged 18–39 years and 24.8% in non-Blacks. The hospitalized PAR was also larger in Blacks aged 40-59 years. CONCLUSIONS Obesity largely impacted in-hospital case-fatality rates among young adults and Black people contaminated by COVID-19. These data highlight the extent of the risk concerning obesity, a highly prevalent chronic condition.
  • Health services utilization in the Brazilian Amazon: panel of two cross-sectional studies Original Articles

    Tiguman, Gustavo Magno Baldin; Silva, Marcus Tolentino; Galvão, Taís Freire

    Abstract in English:

    ABSTRACT OBJECTIVE To investigate the use of health services among adults living in Manaus, Amazonas. METHODS This was a panel of two cross-sectional studies conducted in Manaus in 2015 and 2019. Individuals aged ≥ 18 years were selected by probabilistic sampling and interviewed at home. The study outcomes were doctor visits and hospitalizations in the previous 12 months, and unmet surgical needs. Variations between 2015 and 2019 were tested using chi-squared goodness-of-fit test. Poisson regression with robust variance was employed to calculate the prevalence ratios (PR) of the outcomes with 95% confidence intervals (95%CI). RESULTS The surveys included 5,800 participants in total. Visits to the doctor decreased from 2015 (78.7%) to 2019 (76.3%; p < 0.001), hospital admissions increased from 2015 (7.9%) to 2019 (11.5%; p < 0.001), and unmet surgical needs decreased in the period (15.9% to 12.1%; p < 0.001). These variations were particularly observed in vulnerable individuals – sicker; poorer; non-whites; and those belonging to lower social classes, with less access to education, formal jobs, and health insurance (p < 0.05). Doctor visits were higher in people with fair health status (PR = 1.09; 95%CI 1.06–1.12), health insurance (PR = 1.13; 95%CI 1.09–1.17), and chronic diseases (p < 0.001) but lower in men (PR = 0.87; 95%CI 0.84–0.90) and informal workers (PR = 0.89; 95%CI 0.84–0.94). Hospitalizations were higher in people with worse health statuses (p < 0.001), without partners (PR = 1.27; 95%CI 1.05–1.53), and with multimorbidity (PR = 1.68; 95%CI 1.33–2.12) but lower in men (PR = 0.55; 95%CI 0.44–0.68), older adults (p < 0.001), informal workers (PR = 0.67; 95%CI 0.51–0.89), and unemployed (PR = 0.72; 95%CI 0.53–0.97). Unmet surgical needs were higher in older adults (p < 0.001), middle-class people (PR = 1.24; 95%CI 1.01–1.55), worse health statuses (p < 0.001), and chronic diseases (p < 0.001) but lower in men (PR = 0.76; 95%CI 0.65–0.86). CONCLUSIONS From 2015 to 2019, less people visited the doctor, more were admitted to hospitals, and less were in need of surgery or aware of that need, potentially indicating poorer access to health services.
  • The transmission of visceral leishmaniasis in the municipality of Guarujá, on the Coast of São Paulo state, Brazil Original Articles

    Casanova, Claudio; Motoie, Gabriela; Domingos, Maria de Fátima; Silva, Vanessa Gusmon da; Silva, Mariana Dantas da; Galati, Eunice Aparecida Bianchi; Galvis-Ovallos, Fredy

    Abstract in English:

    ABSTRACT OBJECTIVE To perform an entomological survey, evaluating the circulation of Leishmania spp. in sand flies captured from the new foci of visceral leishmaniasis (VL) in the coastal region of São Paulo state. METHODS Sand flies were captured from November 2016 to September 2018 using light traps of the Centers for Disease Control (CDC), in the neighborhood where VL cases were reported. Leishmania spp. circulation was evaluated by gut dissection and molecular analysis of the females captured. RESULTS Nyssomyia intermedia was the more frequent species (90,7%) within the 1,203 sand flies captured. We found no flagellates in dissected females, but two pools containing females of Ny. intermedia presented DNA of L. infantum. CONCLUSION Our results suggest that Ny. intermedia might be involved in the establishment of this new VL focus in Sao Paulo. However, before incriminating this species as a L. infantum vector, further studies should investigate other vectorial capacity parameters, including competence, survival, and feeding habits.
Faculdade de Saúde Pública da Universidade de São Paulo São Paulo - SP - Brazil
E-mail: revsp@org.usp.br