Revista de Saúde Públicahttps://scielosp.org/journal/rsp/feed/2017-01-30T00:05:00ZVol. 58 - 2024WerkzeugImpact of a research-action on vaccination indicators in the state of Minas Gerais, Brazil10.11606/s1518-8787.20240580054842017-01-30T00:05:00Z2017-01-30T00:05:00ZSouza, Janaina Fonseca AlmeidaSilva, Thales Philipe Rodrigues daOliveira, Thais MoreiraVimieiro, Aline MendesTeixeira, Antônia Maria da SilvaSoares, Adriana CoelhoRibeiro, Elice Eliane NobreFreitas, Giselle Lima deGaspar, Eduarda DantasMatozinhos, Fernanda Penido
<em>Souza, Janaina Fonseca Almeida</em>;
<em>Silva, Thales Philipe Rodrigues Da</em>;
<em>Oliveira, Thais Moreira</em>;
<em>Vimieiro, Aline Mendes</em>;
<em>Teixeira, Antônia Maria Da Silva</em>;
<em>Soares, Adriana Coelho</em>;
<em>Ribeiro, Elice Eliane Nobre</em>;
<em>Freitas, Giselle Lima De</em>;
<em>Gaspar, Eduarda Dantas</em>;
<em>Matozinhos, Fernanda Penido</em>;
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ABSTRACT OBJECTIVE Analyze the impact of the state research-action project on immunization indicators (vaccination coverage – VC, homogeneity of vaccination coverage – HVC, dropout rate – DR, and risk rating) before and after the intervention in municipalities and priority Regional Health Administrations/Regional Health Superintendencies (RHA/RHS). METHODS The state research-action project was a before-after community clinical trial conducted in 212 municipalities belonging to eight RHA/RHS in the state of Minas Gerais, Brazil. The study sample comprised RHA/RHS with a decreasing trend for routine vaccination coverage in children under one year from 2015 to 2020. This study used secondary VC and DR data from 10 immunobiologicals recommended for children younger than two years from January to December 2021 (pre-intervention period, prior to the state research-action project) and from January to December 2022 (post-intervention period). The categorical variables were presented in proportions, and initially, a comparison was made between those of DR, HVC, and the risk rating for the transmission of vaccine-preventable diseases, according to the two periods (2021 and 2022), using the McNemar test. RESULTS All immunization indicators increased after conducting the research-action project. In 2021, 80.66% of the state’s municipalities had a risk rating for the transmission of vaccine-preventable diseases as “high and very high.” In 2022, the value reduced to 68.40%. CONCLUSIONS Risk rating for the transmission of vaccine-preventable diseases is an important mechanism to assist managers in defining priorities. The state research-action project used a method that enabled the construction and execution of unique action plans for each municipality, directing the improvement of immunization indicators in the state.Effects of land cover and air pollution on the risk of preterm births10.11606/s1518-8787.20240580055042017-01-30T00:05:00Z2017-01-30T00:05:00ZMoreira, Tiana C. L.Polizel, Jefferson L.Réquia, Weeberb J.Saldiva, Paulo Hilario NascimentoSilva Filho, Demostenes F. daSaldiva, Silvia Regina Dias MediciMauad, Thais
<em>Moreira, Tiana C. L.</em>;
<em>Polizel, Jefferson L.</em>;
<em>Réquia, Weeberb J.</em>;
<em>Saldiva, Paulo Hilario Nascimento</em>;
<em>Silva Filho, Demostenes F. Da</em>;
<em>Saldiva, Silvia Regina Dias Medici</em>;
<em>Mauad, Thais</em>;
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ABSTRACT OBJECTIVE To evaluate the association between gestational age and green areas, urban built areas, and the concentration of particulate matter 2.5 (PM2.5) in the city of São Paulo, analyzing the irregular distribution of these areas and pollution levels above the recommended level. METHODS The study population consisted of a cohort of live births from 2012, and data from the Live Birth Information System (Sinasc) of the city of São Paulo were used. Using satellite images and supervised classification, the distribution and quantity of green areas and built areas in the city of São Paulo was obtained, as well as the concentrations of PM2.5. Logistic regressions were used to obtain possible associations. RESULTS The results of the study show that a lower percentage of green areas is significantly associated with a higher chance of preterm births. A higher building density was positively associated with the odds ratio for preterm birth. We did not find any significant associations between air pollution (PM2.5) and preterm births. CONCLUSIONS The results of this study show that greener areas are less associated with preterm births when compared with less green areas.Immunization against covid-19 and mortality in hospitalized patients: a retrospective cohort10.11606/s1518-8787.20240580054762017-01-30T00:05:00Z2017-01-30T00:05:00ZFigueiredo, Alexandre Medeiros deMassuda, AdrianoFernandez, MichelleMedeiros Neto, Agostinho Hermes deCarvalho, Marcus
<em>Figueiredo, Alexandre Medeiros De</em>;
<em>Massuda, Adriano</em>;
<em>Fernandez, Michelle</em>;
<em>Medeiros Neto, Agostinho Hermes De</em>;
<em>Carvalho, Marcus</em>;
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ABSTRACT OBJECTIVE To evaluate the effectiveness of vaccines developed against covid-19 in reducing mortality in people hospitalized with severe acute respiratory syndrome (SARS) caused by SARS-CoV-2. METHODS This is a retrospective cohort that evaluated risk factors and the effectiveness of the two-dose vaccination schedule in reducing the mortality of people hospitalized for covid-19 in the state of Paraíba from February to November 2021. The explanatory variables were vaccination status, presence of comorbidities, socioeconomic and demographic characteristics. Descriptive analyses and bivariate and multivariable logistic regression were performed. RESULTS Most hospitalizations and deaths occurred until May 2021. The percentage of patients with a complete vaccination schedule was similar across patients admitted to public and private hospitals and higher in residents of less developed municipalities. Multivariable analysis demonstrated that women (OR = 0.896; 95%CI 0.830–0.967) and people admitted to private hospitals (OR = 0.756; 95%CI 0.679–0.842) were less likely to die. Presence of any comorbidity (OR = 1.627; 95%CI 1.500–1.765) and age ≥ 80 years (OR = 7.426; 95%CI 6.309–8.741) were risk factors for death. Patients with complete vaccination schedule at the time of admission were 41.7% less likely to die (OR = 0.583; 95% CI 0.501–0.679) from covid-19 in the adjusted analysis, as compared to unvaccinated patients. CONCLUSIONS The study reveals that immunization was effective in reducing the likelihood of death from covid-19. The results suggest that greater vaccination coverage in the first half of 2021 would prevent thousands of deaths in the country.Inefficacious drugs against covid-19: analysis of sales, tweets, and search engines10.11606/s1518-8787.20240580054132017-01-30T00:05:00Z2017-01-30T00:05:00ZBrito Junior, Irineu deSaraiva, Flaviane AzevedoBruno, Nathan de CamposSilva, Roberto Fray daHino, Celso MitsuoYoshizaki, Hugo Tsugunobu Yoshida
<em>Brito Junior, Irineu De</em>;
<em>Saraiva, Flaviane Azevedo</em>;
<em>Bruno, Nathan De Campos</em>;
<em>Silva, Roberto Fray Da</em>;
<em>Hino, Celso Mitsuo</em>;
<em>Yoshizaki, Hugo Tsugunobu Yoshida</em>;
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ABSTRACT OBJECTIVE Assess the correlation between the sales of two drugs with no proven efficacy against covid-19, ivermectin and chloroquine, and other relevant variables, such as Google® searches, number of tweets related to these drugs, number of cases and deaths resulting from covid-19. METHODS The methodology adopted in this study has four stages: data collection, data processing, exploratory data analysis, and correlation analysis. Spearman’s method was used to obtain cross-correlations between each pair of variables. RESULTS The results show similar behaviors between variables. Peaks occurred in the same or near periods. The exploratory data analysis showed shortage of chloroquine in the period corresponding to the beginning of advertising for the application of these drugs against covid-19. Both drugs showed a high and statistically significant correlation with the other variables. Also, some of them showed a higher correlation with drug sales when we employed a one-month lag. In the case of chloroquine, this was observed for the number of deaths. In the case of ivermectin, this was observed for the number of tweets, cases, and deaths. CONCLUSIONS The results contribute to decision making in crisis management by governments, industries, and stores. In times of crisis, as observed during the covid-19 pandemic, some variables can help sales forecasting, especially Google® and tweets, which provide a real-time analysis of the situation. Monitoring social media platforms and search engines would allow the determination of drug use by the population and better prediction of potential peaks in the demand for these drugs.Is the Bland-Altman plot method useful without inferences for accuracy, precision, and agreement?10.11606/s1518-8787.20240580054302017-01-30T00:05:00Z2017-01-30T00:05:00ZSilveira, Paulo Sergio PanseVieira, Joaquim EdsonSiqueira, José de Oliveira
<em>Silveira, Paulo Sergio Panse</em>;
<em>Vieira, Joaquim Edson</em>;
<em>Siqueira, José De Oliveira</em>;
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ABSTRACT OBJECTIVE This study aims to propose a comprehensive alternative to the Bland-Altman plot method, addressing its limitations and providing a statistical framework for evaluating the equivalences of measurement techniques. This involves introducing an innovative three-step approach for assessing accuracy, precision, and agreement between techniques, which enhances objectivity in equivalence assessment. Additionally, the development of an R package that is easy to use enables researchers to efficiently analyze and interpret technique equivalences. METHODS Inferential statistics support for equivalence between measurement techniques was proposed in three nested tests. These were based on structural regressions with the goal to assess the equivalence of structural means (accuracy), the equivalence of structural variances (precision), and concordance with the structural bisector line (agreement in measurements obtained from the same subject), using analytical methods and robust approach by bootstrapping. To promote better understanding, graphical outputs following Bland and Altman’s principles were also implemented. RESULTS The performance of this method was shown and confronted by five data sets from previously published articles that used Bland and Altman’s method. One case demonstrated strict equivalence, three cases showed partial equivalence, and one showed poor equivalence. The developed R package containing open codes and data are available for free and with installation instructions at Harvard Dataverse at https://doi.org/10.7910/DVN/AGJPZH. CONCLUSION Although easy to communicate, the widely cited and applied Bland and Altman plot method is often misinterpreted, since it lacks suitable inferential statistical support. Common alternatives, such as Pearson’s correlation or ordinal least-square linear regression, also fail to locate the weakness of each measurement technique. It may be possible to test whether two techniques have full equivalence by preserving graphical communication, in accordance with Bland and Altman’s principles, but also adding robust and suitable inferential statistics. Decomposing equivalence into three features (accuracy, precision, and agreement) helps to locate the sources of the problem when fixing a new technique.Evolution of adolescents’ dietary patterns in Northeast Brazil from 2008 to 201810.11606/s1518-8787.20240580050902017-01-30T00:05:00Z2017-01-30T00:05:00ZMachado, Soraia PinheiroBezerra, Ilana NogueiraSilva, Mariane AlvesD’oran, Maria Helena LimaCunha, Diana BarbosaMoreno, Luis AlbertoSichieri, Rosely
<em>Machado, Soraia Pinheiro</em>;
<em>Bezerra, Ilana Nogueira</em>;
<em>Silva, Mariane Alves</em>;
<em>D’oran, Maria Helena Lima</em>;
<em>Cunha, Diana Barbosa</em>;
<em>Moreno, Luis Alberto</em>;
<em>Sichieri, Rosely</em>;
<br/><br/>
ABSTRACT OBJECTIVE To evaluate the evolution of the dietary patterns of adolescents in the northeast region of Brazil. METHODS Secondary analysis of data from the Pesquisa de Orçamentos Familiares (POF – Household Budget Surveys), collected by the Brazilian Institute of Geography and Statistics (IBGE) in the years 2008–2009 and 2017–2018. A total of 3,095 adolescents were evaluated in 2008–2009 and 3,015 in 2017–2018. Food consumption was assessed using two dietary records in 2008–2009 and two 24-hour recalls in 2017–2018, applied on non-consecutive days. Based on these data, principal components factor analysis (PCFA) was performed, followed by orthogonal rotation of the varimax type, to derive dietary patterns, stratified by sex. The results were described as means or percentage frequencies, with their respective 95% confidence intervals. RESULTS Three main dietary patterns were identified among adolescents from the northeast region of Brazil. Among boys, in 2008–2009, the patterns were called snacks, traditional Brazilian, and coffee; and in 2017–2018, traditional Brazilian, snacks, and mixed, in this order of representativeness of the group’s eating habits. Among female adolescents, in 2008–2009, the patterns were snacks, traditional Brazilian, and coffee; and in 2017–2018, traditional Brazilian, snacks, and processed meats. CONCLUSION The dietary patterns identified in 2008–2009 and 2017–2018 were similar in both genders; however, the snacks pattern, which explained most of the data variability in 2008–2009, was replaced by the traditional Brazilian.Contraindicated use of modern contraceptives among mothers from a Pelotas Birth Cohort10.11606/s1518-8787.20240580055852017-01-30T00:05:00Z2017-01-30T00:05:00ZHouvèssou, Gbènankpon MathiasFarías-Antúnez, SimoneBertoldi, Andréa D.Silveira, Mariângela Freitas da
<em>Houvèssou, Gbènankpon Mathias</em>;
<em>Farías-Antúnez, Simone</em>;
<em>Bertoldi, Andréa D.</em>;
<em>Silveira, Mariângela Freitas Da</em>;
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ABSTRACT OBJECTIVE To describe the prevalence of contraindicated use of combined hormonal contraceptives, progesterone-only contraceptives, and intrauterine devices in mothers participating in the 2015 Pelotas Birth Cohort according to the WHO medical eligibility criteria. METHODS The biological mothers of children belonging to the 2015 Pelotas birth cohort who attended the 48-month follow-up were studied. The 48-month follow-up data were collected from January 1, 2019, to December 31, 2019. Contraindicated use of modern contraceptives was considered to occur when these women presented at least one of the contraindications for the use of modern contraceptives and were using these methods. The prevalence of contraindicated use was calculated according to each independent variable and their respective 95% confidence intervals (95%CI). RESULTS The analyzed sample consisted of 3,053 women who used any modern contraceptive method. The prevalence of contraindicated use of modern contraceptives totaled 25.9% (95%CI: 24.4–27.5). Combined hormonal contraceptives showed the highest prevalence of contraindicated use (52.1%; 95%CI: 49.3–54.8). The prevalence of contraindicated use of modern contraceptives methods was greater in women with family income between one and three minimum wages, a 25–30 kg/m2 body mass index, indication by a gynecologist for the used method, and purchasing the contraceptive method at a pharmacy. The higher the women’s education, the lower the prevalence of inappropriate use of modern contraceptives. CONCLUSION In total, one in four women used modern contraceptives despite showing at least one contraindication. Policies regarding women’s reproductive health should be strengthened.Food environment of bus terminals in the Rio de Janeiro metropolitan region10.11606/s1518-8787.20240580047692017-01-30T00:05:00Z2017-01-30T00:05:00ZJesus, Ana Carolina Castro deBotelho, Laís VargasCanella, Daniela SilvaTavares, Letícia FerreiraCastro Junior, Paulo César Pereira deSilva, Isabela da Costa Gaspar daCardoso, Letícia de Oliveira
<em>Jesus, Ana Carolina Castro De</em>;
<em>Botelho, Laís Vargas</em>;
<em>Canella, Daniela Silva</em>;
<em>Tavares, Letícia Ferreira</em>;
<em>Castro Junior, Paulo César Pereira De</em>;
<em>Silva, Isabela Da Costa Gaspar Da</em>;
<em>Cardoso, Letícia De Oliveira</em>;
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ABSTRACT PURPOSE To describe and analyze the healthiness of formal and informal food establishments in bus terminals of the metropolitan region of the state of Rio de Janeiro. METHOD An audit was conducted in 156 formal and 127 informal food establishments located in 14 bus terminals of the five most populous cities of the metropolitan region of Rio de Janeiro. Proportions of types of establishments and means (95%CI) of food availability indicators in formal and informal settings were calculated. For the formal setting, prices, proportions of accepted payment methods, days and hours of operation, and food categories with displayed advertising were described. RESULTS The healthiness of food establishments in bus terminals was low (less than 36%). On average, ultra-processed food subgroups were 250% more available for purchase than fresh or minimally processed food. Purchasing food at these places was convenient because several forms of payment were available, and the opening hours of the establishments followed the peaks of movement. In addition, 73.3% of the advertising referred to ultra-processed drinks, and the cost-benefit of buying ultra-processed food was better than fresh or minimally processed food. CONCLUSION The food environment of bus terminals in the metropolitan region of Rio de Janeiro promotes unhealthy eating. Regulatory public policies should focus on initiatives to limit the wide availability and advertising of ultra-processed food in spaces of great circulation of people.Evaluation of the GeneXpert MTB/RIF to diagnose tuberculosis in a public health laboratory10.11606/s1518-8787.20240580053062017-01-30T00:05:00Z2017-01-30T00:05:00ZArbués, Mohanna DamascenoRossetti, Maria Lúcia Rosa
<em>Arbués, Mohanna Damasceno</em>;
<em>Rossetti, Maria Lúcia Rosa</em>;
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ABSTRACT OBJECTIVES To evaluate the performance of geneXpert MTB/Rif versus conventional methods (bacilloscopy and culture) in the diagnosis of tuberculosis in a Central Public Health Laboratory (LACEN, Tocantins), Northern Brazil. METHODS Retrospective study, with information from 1,973 suspected cases of tuberculosis from patients treated from January 2015 to December 2020. RESULTS From the culture (reference standard), the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the geneXpert MTB/Rif were 100%, 97%, 74%, 100%, and 97%, respectively, against 85%, 98%, 80%, 98%, and 97% of bacilloscopy. CONCLUSIONS The geneXpert MTB/Rif performed similarly to culture and better than bacilloscopy. Although positive cases with negative culture should be evaluated with caution, its routine use is important for the early detection of tuberculosis.