Resumo em Inglês:

ABSTRACT OBJECTIVE To evaluate the effectiveness of mobile ophthalmic unit screenings and to investigate barriers between community care and resolution of the problem at a tertiary center. METHODS This prospective study evaluated a convenience sample from 10 municipalities in São Paulo State, Brazil. Patients were assessed in the municipality by a mobile ophthalmic unit and underwent a complete ophthalmic consultation. Patients were referred as warranted to a tertiary hospital. RESULTS The mobile ophthalmic unit screened 1,928 individuals and 714 (37%) were referred. The mean age of the referred patients was 57.12 (SD = 19.5) years with best corrected visual acuity of 0.37 (SD = 0.36) logMAR. Forty-seven (6.6%) patients were blind and 185 (26.5%) were visually impaired. Cataracts (44.7%) and pterygium (14.7%) accounted for most referrals. Of those referred, 67.1% presented to the tertiary center. The diagnosis by the mobile ophthalmic unit corresponded to the one by the tertiary center in 88.5% of the cases. There were a significantly higher number of blind and visually impaired persons among those who presented to the hospital. There was a significantly greater attendance among patients living in more distant municipalities from the reference center with a higher number of inhabitants and a greater number of ophthalmologists in the cities of origin (p < 0.05, all comparisons). Complete treatment was performed in 65.6% of patients, and loss to follow-up was the main cause of incomplete treatment in 50.7% of patients. A total of 313 cataract surgeries were performed, which reduced the number of blind patients from 20 to 2 and of visually impaired individuals from 87 to 2 (p < 0.001). CONCLUSIONS Only 37% of the patients assessed by a mobile ophthalmic unit required referral to a tertiary hospital. Among the referred patients, 67.1% presented to the hospital, and complete resolution after treatment was approximately 65.5%. There was a significant improvement in visual acuity and a reduction in the prevalence of blindness and visual impairment postoperatively.

Resumo em Inglês:

ABSTRACT OBJECTIVE: To evaluate the impact of mode of delivery on breastfeeding incentive practices and on neonatal and maternal short and long-term complications. METHODS: A cohort study was conducted between June 2015 and April 2016 with 768 puerperal women from 11 maternities in Sergipe, interviewed in the first 24 hours, 45–60 days and 6–8 months after delivery. Associations between breastfeeding incentive practices, neonatal and maternal, both short-term and late complications, and the exposure variables were evaluated by the relative risk (95%CI) and the Fisher exact test. RESULTS: The C-section newborns had less skin-to-skin contact immediately after delivery (intrapartum C-section: 0.18, 95%CI 0.1–0.31 and elective C-section: 0.36, 95%CI 0.27–0.47) and less breastfeeding within one hour of birth (intrapartum C-section: 0.43, 95%CI 0.29–0.63 and elective C-section: 0.44, 95%CI 0.33–0.59). Newborns from elective C-section were less frequently breastfed in the delivery room 0.42 (95%CI 0.2–0.88) and roomed-in less 0.85 (95%CI 0.77–0.95). Women submitted to intrapartum C-section had greater risk of early complications 1.3 (95%CI 1.04–1.64, p = 0.037) and sexual dysfunction 1.68 (95%CI 1.14–2.48, p = 0.027). The frequency of neonatal complications, urinary incontinence and depression according to the mode of delivery was similar. CONCLUSIONS: The C-section was negatively associated with breastfeeding incentive practices; in addition, C-section after labor increased the risk of early maternal complications and sexual dysfunction.

Resumo em Inglês:

ABSTRACT OBJECTIVE: To analyze the cost effectiveness of the diagnostic program for the germline mutation in BRCA1/2 genes and of preventative strategies for the relatives of patients diagnosed with ovarian cancer associated with this mutation. METHODS: The study analyzed the cost effectiveness by developing an analysis of the Markov decision process from the perspective of the National Health System. The strategies compared reflect upon the adoption of genetic testing and preventative strategies for relatives or the usual care currently proposed. The incremental cost-effectiveness ratio was expressed in terms of cost per case avoided. The sensitivity analysis was performed in a univariate and deterministic manner. RESULTS: The study showed increments for effectiveness and for costs when performing genetic testing and adopting prophylactic measures for family members. The incremental cost-effectiveness ratio was estimated at R$908.58 per case of cancer avoided, a figure considered lower than the study's cost-effectiveness threshold (R$7,543.50). CONCLUSIONS: The program analyzed should be considered a cost-effective strategy for the national situation. Studies in various other countries have reached similar conclusions. One possible ramification of this research might the need to perform a budgetary-impact analysis of making the program one of the country's health policies.

Resumo em Inglês:

ABSTRACT OBJECTIVE: To analyze the moderator effect of socioeconomic status in the association between the perceived environment and active commuting to school. METHODS: A total of 495 adolescents and their parents were interviewed. Perceived environment was operationalized in traffic and crime safety and assessed with the Neighborhood Environment Walkability Scale. Active commuting was self-reported by the adolescents, categorized in walking, bicycling or skating at least one time/week. Socioeconomic status was used as moderator effect, reported from adolescents' parents or guardians using Brazilian standardized socioeconomic status classification. Analyses were performed with Poisson regression on Stata 12.0. RESULTS: Prevalence of active commuting was 63%. Adolescents with low socioeconomic status who reported “it is easy to observe pedestrians and cyclists” were more likely to actively commute to school (PR = 1.18, 95%CI 1.03–1.13). Adolescents with low socioeconomic status whose parents or legal guardians reported positively to “being safe crossing the streets” had increased probability of active commuting to school (PR = 1.10, 95%CI 1.01–1.20), as well as those with high socioeconomic status with “perception of crime” were positively associated to the outcome (PR = 1.33, 95%CI 1.03–1.72). CONCLUSIONS: Socioeconomic status showed moderating effects in the association between the perceived environment and active commuting to school.

Resumo em Português:

RESUMO O exitoso Programa Nacional de Imunizações do Brasil tem vivenciado grande desafio com relação às coberturas vacinais infantis, que têm apresentado queda. Diversos aspectos estão relacionados, mas certamente a hesitação vacinal vem se fortalecendo como uma das principais preocupações dos gestores e pesquisadores brasileiros. Hesitação vacinal é o atraso em aceitar ou a recusa das vacinas recomendadas quando elas estão disponíveis nos serviços de saúde, sendo um fenômeno que varia ao longo do tempo, do local e dos tipos de vacinas. Indivíduos hesitantes situam-se entre os dois polos de aceitação e recusa total da vacinação. A hesitação vacinal não é novidade em países europeus e norte-americanos e, mesmo no Brasil, ela já vem sendo estudada ainda que sob outra denominação. A queda das coberturas vacinais observadas a partir de 2016 reitera a relevância do tema, que deve ser mais bem compreendido por meio de investigações científicas.

Resumo em Inglês:

ABSTRACT The successful Programa Nacional de Imunizações do Brasil (Brazilian National Immunization Program) has been experiencing a major challenge with regard to vaccination coverage for children, which has been dropping. Several aspects are related, but certainly vaccine hesitancy has been strengthening itself as one of the main concerns of Brazilian public administrators and researchers. Vaccine hesitancy is the delay in acceptance or refusal despite having the recommended vaccines available in health services, being a phenomenon that varies over time, over location and over types of vaccines. Hesitant individuals are between the two poles of total acceptance and refusal of vaccination. Vaccine hesitancy is nothing new in European and North-American countries, and even in Brazil, it has been studied even if under another name. The drop of vaccination coverage observed from 2016 on reiterates the relevance of the theme, which must be better understood through scientific research.

Resumo em Inglês:

ABSTRACT OBJECTIVE To establish the diagnostic accuracy of the Brazilian version of the General Practitioner Assessment of Cognition (GPCOG-Br) compared to the Mini-Mental State Examination (MMSE) in individuals with low educational level. METHODS Ninety-three patients (≥ 60 years old) from Brazilian primary care units provided sociodemographic, cognitive, and functional data. Receiver operating characteristics, areas under the curve (AUC) and logistic regressions were conducted. RESULTS Sixty-eight patients with 0–4 years of education. Cases (n = 44) were older (p = 0.006) and performed worse than controls (n = 49) on all cognitive or functional measures (p < 0.001). The GPCOG-Br demonstrated similar diagnostic accuracy to the MMSE (AUC = 0.90 and 0.91, respectively) and similar positive and negative predictive values (PPV/NPV, respectively: 0.79/0.86 for GPCOG-Br and 0.79/0.81 for MMSE). Adjusted cut-points displayed high sensitivity (all 86%) and satisfactory specificity (65%–80%). Lower educational level predicted lower cognitive performance. CONCLUSIONS The GPCOG-Br is clinically well-suited for use in primary care.

Resumo em Português:

RESUMO OBJETIVO Analisar a associação entre a violência por parceiro íntimo e a não realização do exame citopatológico nos últimos três anos. MÉTODOS Estudo transversal, em 26 unidades de saúde do município de Vitória, ES, no período de março a setembro de 2014. A amostra foi constituída por 706 usuárias do serviço de atenção primária, com idade entre 30 e 59 anos. Foram coletados dados sobre o rastreamento do câncer de colo do útero, além da caracterização sociodemográfica, comportamental, obstétrica e ginecológica das mulheres por meio de entrevista e aplicado o instrumento recomendado pela Organização Mundial da Saúde para identificar a experiência de violência. A análise foi realizada por teste de associação do qui-quadrado, tendência linear para variáveis ordinais e análise de regressão de Poisson com variância robusta. RESULTADOS Entre as participantes, 14% (IC95% 12,0–17,2) estavam com o exame de Papanicolaou em atraso. A maior prevalência de não realização do exame foi entre mulheres de menor escolaridade, em união consensual, menor renda, fumantes e com histórico de uso de drogas, coitarca antes dos 15 anos, três ou mais gestações e dois ou mais parceiros nos últimos 12 meses. Mulheres em situação de violência sexual e física cometida pelo parceiro íntimo apresentaram, respectivamente, 1,64 (IC95% 1,03–2,62) e 1,94 (IC95% 1,28–2,93) vezes mais prevalência de atraso no exame de Papanicolaou quando comparadas às não vítimas. CONCLUSÕES A violência apresenta-se como um agravo importante e com impacto negativo na saúde da mulher. Mulheres vitimizadas, física ou sexualmente, por seus companheiros, estão mais vulneráveis a não realização do exame de Papanicolaou e, consequentemente, têm menos oportunidades de detecção precoce do câncer de colo do útero.

Resumo em Inglês:

ABSTRACT OBJECTIVE To analyze the association between intimate partner violence and not performing the cytopathologic test in the last three years. METHODS It is a transversal study, performed in 26 health units in the city of Vitória, state Espírito Santo, from march to September 2014. The sample was constituted by 106 primary care female users, aging from 30 to 59 years-old. Data on cervical cancer screening were collected, besides the women’s sociodemographic, behavior, obstetric, and gynecological characteristics by an interview, and the World Health Organization recommended tool for identifying violence experiences was applied. The analysis was performed through the chi-square test for association, linear trend for ordinal variables, and the Poisson regression analysis with robust variance. RESULTS Among the participating women, 14% (95%CI 12.0–17.2) had overdue Pap tests. Most women who did not perform the test had lower schooling levels, lower income, were smokers, in an unmarried union, having had their sexual debut before 15 years-old, three or more pregnancies, and two or more partners in the last 12 months. Women who suffered intimate partner sexual and physical violence were, respectively, 1.64 (95%CI -1.03–2.62) and 1.94 (95%CI 1.28–2.93) times more delayed in the Pap tests than non-victims. CONCLUSIONS Violence is a significant exacerbating factor and affects women’s health negatively. Women who are physically or sexually victimized by their partners are more vulnerable to not performing Pap tests and, consequently, have fewer chances of early diagnosing cervical cancer.

Resumo em Português:

RESUMO OBJETIVO Realizar uma análise de custo-efetividade do parto vaginal e da cesariana eletiva para gestantes de risco habitual. MÉTODOS A perspectiva adotada foi a da saúde suplementar, subsistema de saúde financiador da assistência obstétrica privada, representado no Brasil por operadoras de planos de saúde. As populações de referência foram as gestantes de risco habitual, que poderiam ser submetidas ao parto vaginal ou à cesariana eletiva, subdivididas em primíparas e multíparas com uma cicatriz uterina prévia. Foi construído um modelo de decisão analítico que incluiu a escolha pelos tipos de parto, consequências em saúde para mãe e recém-nascido da internação para o parto à alta da maternidade. As medidas de efetividade foram identificadas a partir da literatura científica. Os dados de custos foram obtidos pela consulta aos profissionais de saúde, tabelas das operadoras dos planos de saúde e publicações de referências de preços de recursos de saúde. RESULTADOS O parto vaginal foi dominante em comparação com a cesariana eletiva para gestantes de risco habitual primíparas e apresentou menor custo (R$5.210,96 versus R$5.753,54) e melhor ou igual efetividade para todos os desfechos avaliados. Para multíparas com uma cicatriz uterina prévia, a cesariana mostrou-se com custo inferior (R$5.364,07) ao do parto vaginal (R$5.632,24) e melhor ou igual efetividade, portanto mais eficiente para essa população. CONCLUSÕES É necessário o controle e a auditoria das cesarianas sem indicação clínica, destacadamente em primíparas, contribuindo para a gestão da atenção perinatal.

Resumo em Inglês:

ABSTRACT OBJECTIVE To conduct a cost-effectiveness analysis of natural childbirth and elective C-section for normal risk pregnant women. METHODS The study was conducted from the perspective of supplemental health, a health subsystem that finances private obstetric care, represented in Brazil by health plan operators. The reference populations were normal risk pregnant women, who could undergo natural childbirth or elective C-section, subdivided into primiparous and multiparous women with previous uterine scar. A decision analysis model was constructed including choice of delivery types and health consequences for mother and newborn, from admission for delivery to maternity hospital discharge. Effectiveness measures were identified from the scientific literature, and cost data obtained by consultation with health professionals, health plan operators’ pricing tables, and pricing reference publications of health resources. RESULTS Natural childbirth was dominant compared with elective C-section for primiparous normal risk pregnant women, presenting lower cost (R$5,210.96 versus R$5,753.54) and better or equal effectiveness for all evaluated outcomes. For multiparous women with previous uterine scar, C-section presented lower cost (R$5,364.07) than natural childbirth (R$5,632.24), and better or equal effectiveness; therefore, C-section is more efficient for this population. CONCLUSIONS It is necessary to control and audit C-sections without clinical indication, especially with regard to primiparous women, contributing to the management of perinatal care.

Resumo em Português:

RESUMO OBJETIVO Estimar a cobertura das atividades de controle da leishmaniose visceral e relacioná-las com a ocorrência de leishmaniose visceral em humanos em área urbana endêmica. MÉTODOS Foram considerados como população de estudo os casos de leishmaniose visceral em humanos e em cães avaliados por inquérito sorológico censitário realizado em Araçatuba, SP, de 2007 a 2015. Os casos de leishmaniose visceral em humanos foram geocodificados pelo endereço de residência dos pacientes e, os cães, pelo endereço de residências dos respectivos tutores. Foram calculadas as coberturas do inquérito sorológico, da eutanásia e de borrifação de inseticida, as soroprevalências caninas e as taxas de incidência de leishmaniose visceral em humanos. A relação entre a leishmaniose visceral em humanos e as medidas de controle, bem como a soroprevalência foram avaliadas por comparação de mapas e por meio de regressão linear. A relação entre a doença canina e a humana também foi avaliada por meio da função K de Ripley . RESULTADOS As taxas de incidência de leishmaniose visceral em humanos apresentaram um período de declínio (2007 a 2009) e um período de estabilidade (2010 a 2015), comportamento semelhante ao das soroprevalências caninas. Em geral, a cobertura das medidas de controle foi baixa e a não associação com a incidência de leishmaniose visceral em humanos pode ser consequência do período analisado e do número pequeno de unidades analisadas (setores da Superintendência de Controle de Endemias). A distribuição dos casos humanos apresentou dependência espacial com a distribuição dos cães soropositivos de 2007 a 2009. CONCLUSÕES Este trabalho reafirmou a relação entre a ocorrência da doença no homem e no cão, verificou a diminuição das taxas de leishmaniose visceral em humanos e em cães em Araçatuba ao longo do tempo, mesmo em baixa cobertura das atividades de controle. Entretanto, novos estudos são necessários para averiguar se fatores além das atividades de vigilância e controle estariam envolvidos na diminuição das incidências.

Resumo em Inglês:

ABSTRACT OBJECTIVE Estimate the coverage of control measures of visceral leishmaniasis and relate them with the occurrence of human visceral leishmaniasis in endemic urban area. METHODS Cases of human and canine visceral leishmaniasis were considered as study population and evaluated by a serological survey conducted in Araçatuba, state São Paulo, from 2007 to 2015. The cases of human visceral leishmaniasis were geocoded by the address of the patients and the canine disease by the address of the dogs’ owners. The coverage of serological survey, euthanasia, and insecticide spraying was calculated, as well as the canine seroprevalence and the incidence rates of human visceral leishmaniasis. The relationship between human visceral leishmaniasis and control measures was evaluated, as well as the seroprevalence by comparing maps and by linear regression. The relationship between the canine and the human disease was also evaluated by the Ripley’s K function. RESULTS The incidence rates of human visceral leishmaniasis showed a period of decline (2007 to 2009) and a period of stability (2010 to 2015), a behavior similar to that of canine seroprevalence. In general, the coverage of control measures was low, and the non-association with the incidence of human visceral leishmaniasis can be a result of the period analyzed and of the small number of analyzed units (sectors of the Superintendence for the Control of Endemic Diseases). The distribution of human cases showed spatial dependence with the distribution of seropositive dogs from 2007 to 2009. CONCLUSIONS This study reaffirmed the relationship between the occurrence of the disease in humans and dogs, it verified a decrease in the rates of visceral leishmaniasis in Araçatuba over time, even at low coverage of control activities. However, further studies are needed to determine if factors beyond monitoring and control measures are involved in the reduction of incidences.

Resumo em Português:

RESUMO OBJETIVO Descrever o emprego das etapas da tomada de decisões baseada em evidências para implementação de programas de promoção da atividade física. MÉTODOS Trata-se de um estudo descritivo, transversal, com abordagem quali-quantitativa, realizado com secretários municipais de saúde escolhidos intencionalmente por representantes das regionais de saúde do estado do Paraná. Ao todo, 27 secretários participaram de uma entrevista telefônica composta por 17 questões abertas. A análise de conteúdo foi conduzida segundo as categorias de um modelo de tomada de decisões baseada em evidências composto de sete etapas . RESULTADOS Nenhum dos participantes empregou todas as etapas do modelo de tomada de decisões baseada em evidências. As etapas mais mencionadas foram: avaliação do programa (33,3%), uso de evidências da literatura (22,2%) e identificação do problema (22,2%). As etapas menos reportadas foram: quantificação do problema (14,8%), desenvolvimento e priorização de ações (14,8%), desenvolvimento do plano de ação (14,8%) e avaliação da comunidade (3,7%). CONCLUSÕES O emprego da tomada de decisões baseada em evidências no contexto da promoção da atividade física apresentou-se incipiente entre os secretários de saúde do estado do Paraná. Sugere-se ampliar a disseminação e o treinamento para o uso de tomada de decisões baseada em evidências entre os gestores municipais a fim de ampliar a efetividade das ações de promoção da atividade física.

Resumo em Inglês:

ABSTRACT OBJECTIVE To describe the steps involved in evidence-based decision making for the implementation of programs aimed at the promotion of physical activity. METHODS It is a descriptive, cross-sectional study with quali-quantitative approach, held with municipal health secretaries chosen deliberately by regional health representatives of the state of Paraná. A total of 27 secretaries participated in a telephone interview consisting of 17 open questions. Content analysis was conducted according to the categories of an evidence-based decision-making model consisting of seven steps. RESULTS None of the participants employed every step of the evidence-based decision-making model. The steps that were most often mentioned included: evaluation of the program (33.3%), use of evidence from the literature (22.2%) and identification of the problem (22.2%). The steps that were reported the least included: quantification of the problem (14.8%), development and prioritization of actions (14.8%), development of the plan of action (14.8%) and evaluation of the community (3.7%). CONCLUSIONS The use of evidence-based decision making in the context of the promotion of physical activity was shown to be incipient among the health secretaries of the state of Paraná. We suggest widening dissemination and training on the use of evidence-based decision making among municipal administrators to increase the effectiveness of actions for promotion of physical activity.

Resumo em Espanhol:

RESUMEN OBJETIVO Analizar la prevalencia de las agresiones sexuales intrafamiliares y extrafamiliares en adolescentes del Perú y su asociación con el consumo de alcohol. MÉTODOS Se utilizó un muestreo probabilístico bietápico y estratificado para seleccionar estudiantes varones y mujeres de educación secundaria de todo el Perú. Los datos de 54,756 estudiantes que incluían información demográfica, sobre consumo de alcohol y drogas, y agresión sexual fueron incluidos en el estudio. En el análisis estadístico se consideró el muestreo complejo y se condujeron dos análisis independientes por el tipo de agresión sexual (intrafamiliar y extrafamiliar), estratificado por el sexo de la víctima. RESULTADOS La prevalencia de vida de las agresiones sexuales intrafamiliares (5.4%, IC95% 5.0–5.8) fue similar al de las agresiones extrafamiliares (6.1%, IC95% 5.6–6.6). El consumo de alcohol en el último año se asoció con las agresiones sexuales intrafamiliares y extrafamiliares que ocurrieron en el mismo periodo después de ajustar por los factores de confusión. El consumo de alcohol en el último año se asoció a las formas no físicas y físicas de agresión sexuales intrafamiliares y extrafamiliares en el análisis desagregado por tipo de agresión. El consumo de alcohol en el último año se asoció con las violaciones sexuales extrafamiliares sólo entre las mujeres (ORa = 2.8; IC95% 1.3–5.9). CONCLUSIONES La agresión sexual de adolescentes mujeres y varones por miembros familiares es una forma frecuente de victimización que se asocia al consumo de alcohol en el Perú. Es importante indagar por esta forma de victimización en adolescentes, especialmente los que consumen alcohol.

Resumo em Inglês:

ABSTRACT OBJECTIVE Analyze the prevalence of intrafamilial and extrafamilial sexual assault in adolescents of Peru and its association with alcohol consumption. METHODS We used a two-step and stratified probabilistic sampling to select male and female students in secondary education from all over Peru. The study included data from 54,756 students with information on demographics, alcohol and drug use, and sexual assault. The statistical analysis considered the complex sampling and we conducted two independent analyses by type of sexual assault (intrafamilial and extrafamilial), stratified by the sex of the victim. RESULTS The prevalence of life of intrafamilial sexual assaults (5.4%, 95%CI 5.0–5.8) was similar to that of extrafamilial sexual assaults (6.1%, 95%CI 5.6–6.6). Alcohol consumption in the past year was associated with intrafamilial and extrafamilial sexual assaults that occurred in the same period after adjusting for confounders. Alcohol consumption in the past year was associated with non-physical and physical forms of intrafamilial and extrafamilial sexual assaults in the disaggregated analysis by type of assault. Alcohol consumption in the past year was associated with extrafamilial rape only among females (ORa = 2.8; 95%CI 1.3–5.9). CONCLUSIONS Sexual assault against adolescent males and females by family members is a frequent form of victimization that is associated with alcohol consumption in Peru. It is important to examine this form of victimization among adolescents, especially those who consume alcohol.

Resumo em Português:

RESUMO OBJETIVO Avaliar a efetividade da terapia antirretroviral e fatores associados segundo o tipo de esquema utilizado: medicamento em dose fixa combinada ou múltiplos medicamentos e doses. MÉTODOS Coorte prospectiva não concorrente de 440 pacientes que iniciaram terapia antirretroviral entre janeiro de 2014 e dezembro de 2015 em Belo Horizonte, MG. A efetividade foi definida como supressão viral (carga viral [CV] < 50 cópias/ml) e avaliada após seis e 12 meses de tratamento. Dados sociodemográficos, clínicos e comportamentais foram coletados de prontuário clínico e de sistemas de informação. A análise múltipla da efetividade global foi realizada por regressão logística. RESULTADOS A maioria dos pacientes iniciou terapia antirretroviral com múltiplos medicamentos e doses (58%). Aos seis meses, a supressão viral global foi 74,6%, maior entre pacientes que utilizaram dose fixa combinada (80,6%; p = 0,04). Aos 12 meses, 83,2% dos pacientes atingiram supressão viral, sem diferença entre os grupos (p = 0,93). Fatores independentemente associados à supressão viral em seis e 12 meses variaram, e foram negativamente associados à efetividade: CV ≥ 100.000 cópias/ml, sintomas definidores de aids, maior intervalo de tempo entre diagnóstico e início da terapia antirretroviral, troca de antirretroviral e consumo de tabaco ou drogas ilícitas (p < 0,05). Fatores positivamente associados à supressão viral incluíram adesão à terapia antirretroviral e categoria de risco/exposição de homens que fazem sexo com homens (p < 0,05). Atingir supressão viral aos seis meses foi o principal preditor de efetividade em um ano (OR = 8,96; p < 0,01). CONCLUSÕES A supressão viral foi elevada e superior para pacientes que utilizaram esquemas de dose fixa combinada aos seis meses. Fatores clínicos, comportamentais e relacionados à terapia antirretroviral influenciaram a supressão viral e evidenciam a necessidade de intervenções para aumentar o diagnóstico, o início precoce e a adesão dos pacientes à terapia antirretroviral, bem como reduzir o uso de drogas ilícitas e tabaco nesta população.

Resumo em Inglês:

ABSTRACT OBJECTIVE To evaluate the effectiveness of antiretroviral therapy and the associated factors according to the type of regimen used: Single Tablet Regimen or Multiple Tablet Regimen. METHODS Prospective cohort of 440 patients (male, 74.3%, median age, 36 years old) who initiated antiretroviral therapy between Jan/14 and Dec/15 at a referral service in Belo Horizonte. Efficacy was defined as viral suppression (viral load, VL < 50 copies/ml) and evaluated after six and twelve months of treatment. Sociodemographic, clinical and behavioral data were collected from clinical charts and from Information Systems. Multivariate analysis of overall effectiveness was performed by logistic regression. RESULTS Most patients initiated Multiple Tablet Regimen antiretroviral therapy (n = 255, 58%). At six months, overall viral suppression was 74.6%, being higher among patients who used Single Tablet Regimen (80.6%, p = 0.04). At twelve months, 83.2% of patients reached viral suppression, with no difference between groups (p = 0.93). Factors independently associated with viral suppression at six and twelve months varied, being negatively associated with effectiveness: VL ≥ 100,000 copies/ml, symptoms of AIDS, longer interval time between diagnosis and initiation of antiretroviral therapy, antiretroviral switching, smoking or current illicit drugs usage (p < 0.05). Factors positively associated with viral suppression included adherence to antiretroviral therapy and category of risk/exposure of men who have sex with men (p < 0.05). Reaching viral suppression at six months was the main predictor of effectiveness at one year (OR = 8.96 and p < 0.01). CONCLUSIONS Viral suppression was high and better results were achieved for patients who used Single Tablet Regimen regimens at six months. Clinical, behavioral, and antiretroviral therapy -related factors influence viral suppression and highlight the need for interventions to increase early diagnosis and initiation of antiretroviral therapy, patient’s adherence, and to reduce illicit drugs and cigarette smoking in this population.

Resumo em Espanhol:

RESUMEN OBJETIVO Identificar los gradientes socioeconómicos en medidas del desarrollo y bienestar en menores de tres años en Fortaleza, Nordeste de Brasil. MÉTODOS Se recolectó información a través de una encuesta socioeconómica, toma de medidas antropométricas, observación del ambiente en el hogar y aplicación del Test de Denver II de 2.755 niños de cero a 28 meses potenciales beneficiarios del programa Cresça com Seu Filho en Fortaleza. Estos niños fueron seleccionados aleatoriamente de un universo identificado a partir del registro administrativo del Catastro Único del Ministerio de Desarrollo Social de Brasil. Para el análisis se reportan estadísticas descriptivas, correlaciones de Pearson y diferencias de medias. RESULTADOS Las tasas de desnutrición crónica y el sobrepeso fueron iguales a 7,0%. Los resultados del Test de Denver II indicaron que las áreas en las que los niños presentan un mayor rezago en su desarrollo, cuando se compararon con la muestra de referencia internacional fueron personal-social (23,0%) y lenguaje (20,0%). Las prácticas parentales medidas por dos sub-escalas del Hom e Observation of the Enviroment fueron pobres, solo el 14,0% de las familias reportaron tener dos o más libros en el hogar y 35,0% de los hogares reportaron haberle pegado a su hijo en los últimos tres días. CONCLUSIONES Se identifican gradientes socioeconómicos claros en los indicadores antropométricos, las pautas de crianza y en la prueba Denver II (especialmente en el dominio de lenguaje). Los niños pertenecientes a los hogares más pobres, así como hijos de madres con menor nivel educativo, presentan un desempeño bajo en la mayoría de las medidas.

Resumo em Inglês:

ABSTRACT OBJECTIVE To identify the socioeconomic gradients in the measures of development and well-being of children under three years of age in Fortaleza, Northeastern Brazil. METHODS We compiled information using a socioeconomic survey instrument, collecting anthropometric measurements, observing the home environment, and applying the Denver Test II to 2,755 children aged between zero and 28 months who are potential beneficiaries of the Cresça com Seu Filho program in Fortaleza. These children were randomly selected from a universe identified from the administrative record of the Cadastro Único of the Ministry of Social Development of Brazil. For the analysis, we reported descriptive statistics, Pearson correlations, and mean differences. RESULTS Rates of chronic malnutrition and overweight were 7.0%. The results of the Denver II test indicated that personal social (23%) and language (20%) are the domains in which children have the highest developmental delay, when compared with the international reference sample. Parental practices measured by two sub-scales of the Home Observation of the Environment Inventory were poor, with only 14.0% of families having two or more books in the home and 35.0% of the households reporting having spanked their child in the past three days. CONCLUSIONS We identified clear socioeconomic gradients in the anthropometric indicators, parenting practices, and the Denver Test II (especially in the language domain). Children from poorer households, as well as children of mothers with lower education levels, perform poorly on most measures.

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ABSTRACT OBJECTIVE To evaluate, in a population-based approach, the association of extreme sleep duration with sociodemographic factors, health, and well-being. METHODS We analyzed the data from the 2014/2015 Health Survey in the city of Campinas, State of São Paulo, Brazil (ISACamp), performed with 1,969 individuals (≥ 20 years old). Associations between the independent variable and short (≤ 6 hours) and long (≥ 9 hours) sleep were determined using the Rao-Scott chi-square test. The analyses were adjusted with multinomial logistic regression models. RESULTS Men, individuals aged 40 to 59, those with higher schooling, those who have one (OR = 1.47, 95%CI 1.02–2.12), two (OR = 1.73, 95%CI 1.07–2.80), or three or more (OR = 1.62, 95%CI 1.16–2.28) chronic diseases, and those with three or more health problems (OR = 1.96, 95%CI 1.22–3.17) were more likely to have a short sleep. The chance of long sleep was higher in widowers and lower in those who have more years of schooling, with higher income, worked, lived with more residents at home, and reported three or more diseases (OR = 0.68, 95%CI 0.48–0.97) and health problems. The chance of either short (OR = 2.41, 95%CI 1.51–3.87) or long sleep (OR = 2.07, 95%CI 1.23–3.48) was higher in unhappy individuals. CONCLUSIONS These findings highlight the higher chance of short sleep duration among men, among persons in productive age, and among those with a higher level of schooling in a Brazilian city. The association of short sleep with comorbidities and the association of happiness with extremes of sleep duration were also important results to understand the relation of sleep duration with health and well-being.

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ABSTRACT OBJECTIVE To describe and assess currently used area-based measures of deprivation in Brazil for health research, to the purpose of informing the development of a future small area deprivation index. METHODS We searched five electronic databases and seven websites of Brazilian research institutions and governmental agencies. Inclusion criteria were: studies proposing measures of deprivation for small areas (i.e., finer geography than country-level) in Brazil, published in English, Portuguese or Spanish. After data-extraction, results were tabulated according to the area level the deprivation measure was created for and to the dimensions of deprivation or poverty included in the measures. A narrative synthesis approach was used to summarize the measures available, highlighting their utility for public health research. RESULTS A total of 7,199 records were retrieved, 126 full-text articles were assessed after inclusion criteria and a final list of 30 articles was selected. No small-area deprivation measures that have been applied to the whole of Brazil were found. Existing measures were mainly used to study infectious and parasitic diseases. Few studies used the measures to assess inequalities in mortality and no studies used the deprivation measure to evaluate the impact of social programs. CONCLUSIONS No up-to-date small area-based deprivation measure in Brazil covers the whole country. There is a need to develop such an index for Brazil to measure and monitor inequalities in health and mortality, particularly to assess progress in Brazil against the Sustainable Development Goal targets for different health outcomes, showing progress by socioeconomic groups.

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RESUMO OBJETIVO Avaliar o plano de amostragem do Inquérito de Saúde do Município de São Paulo (ISA-Capital 2015) em relação à precisão das estimativas e à conformação de domínios de estudo pelas coordenadorias de saúde do município de São Paulo. MÉTODOS Descrição de população e domínios de estudo, procedimentos de amostragem, incluindo estratificação, cálculo do tamanho da amostra e sorteio de unidades amostrais do Inquérito de Saúde do Município de São Paulo, 2015. As estimativas de proporções foram analisadas em relação à precisão, por meio do coeficiente de variação e do efeito do delineamento. Foram considerados adequados coeficientes menores do que 30% no nível regional e 20% no municipal, e efeitos do delineamento menores do que 1,5. Para considerar adequada a estratégia de estabelecimento das Coordenadorias de Saúde como domínios, foi verificado que, dentro das coordenadorias, as estimativas de proporções para grupos de idade e sexo tinham a precisão mínima aceitável. Os parâmetros estimados referiram-se aos temas: uso de serviços, morbidade e autoavaliação em saúde. RESULTADOS Foram sorteados 150 setores censitários, 30 em cada Coordenadoria de Saúde, sorteados e visitados 5.469 domicílios ocupados, e realizadas 4.043 entrevistas. Das 115 estimativas feitas para os domínios de estudo, 97,4% apresentaram coeficientes de variação menores do que 30% e 82,6% menores do que 20%. Das 24 estimativas feitas para o total do município, 23 apresentaram coeficiente de variação menor do que 20%. Mais de dois terços das estimativas do efeito do delineamento foram inferiores a 1,5, valor previsto no cálculo do tamanho da amostra, e o efeito do delineamento foi menor do que dois para 88%. CONCLUSÕES A amostra do ISA-Capital 2015 gerou estimativas situadas nos patamares previstos de precisão, tanto as de nível municipal como regional. Foi acertada a decisão de estabelecer as coordenadorias regionais de saúde do município de São Paulo como domínios de estudo.

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ABSTRACT OBJECTIVE To evaluate the sampling plan of the Health Survey of the City of São Paulo (ISA-Capital 2015) regarding the accuracy of estimates and the conformation of domains of study by the Health Coordinations of the city of São Paulo, Brazil. METHODS We have described the population, domains of study, and sampling procedures, including stratification, calculation of sample size, and random selection of sample units, of the Health Survey of the City of São Paulo, 2015. The estimates of proportions were analyzed in relation to precision using the coefficient of variation and the design effect. We considered suitable the coefficients below 30% at the regional level and 20% at the city level and the estimates of the design effect below 1.5. We considered suitable the strategy of establishing the Health Coordinations as domains after verifying that, within the coordinations, the estimates of proportions for the age and sex groups had the minimum acceptable precision. The estimated parameters were related to the subjects of use of services, morbidity, and self-assessment of health. RESULTS A total of 150 census tracts were randomly selected, 30 in each Health Coordination, 5,469 households were randomly selected and visited, and 4,043 interviews were conducted. Of the 115 estimates made for the domains of study, 97.4% presented coefficients of variation below 30%, and 82.6% were below 20%. Of the 24 estimates made for the total of the city, 23 presented coefficient of variation below 20%. More than two-thirds of the estimates of the design effect were below 1.5, which was estimated in the sample size calculation, and the design effect was below 2.0 for 88%. CONCLUSIONS The ISA-Capital 2015 sample generated estimates at the predicted levels of precision at both the city and regional levels. The decision to establish the regional health coordinations of the city of São Paulo as domains of study was adequate.

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RESUMO OBJETIVO Descrever os principais riscos do trabalho de cortadores de cana-de-açúcar e seus efeitos na saúde dos trabalhadores. MÉTODOS Revisão critica de artigos, com pesquisa bibliográfica realizada nas bases de dados PubMed, SciELO Medline, e Lilacs. Foram empregadas as palavras-chave: sugarcane workers, sugarcane cutters, s ugarcane harvesting , cortadores de cana-de-açúcar e colheita de cana-de-açúcar. Os critérios de inclusão foram artigos publicados entre janeiro de 1997 a junho de 2017, que avaliaram as condições de trabalho e os efeitos na saúde em trabalhadores cortadores de cana-de-açúcar. Foram excluídos aqueles que não tratassem do impacto do trabalho no corte da cana-de-açúcar queimada e não queimada na saúde do cortador. O grupo final de manuscritos foi selecionado pelo autor principal deste estudo e revisado por um coautor. As discordâncias foram resolvidas por consenso usando os critérios de inclusão e exclusão predefinidos e, quando necessário, a decisão final foi realizada consultando um terceiro coautor. RESULTADOS De 89 artigos encontrados, 52 atenderam aos critérios de seleção e foram avaliados. Os estudos mostraram que os cortadores trabalham em condições de sobrecarga física e mental, sobrecarga térmica, exposição a poluentes e sujeitos a acidentes. Os principais efeitos observados foram respiratórios, cardiovasculares, renais, osteomusculares, estresse por calor, desidratação, genotóxicos e decorrente de acidentes. CONCLUSÕES O trabalho no corte manual da cana-de-açúcar, principalmente da cana-de-açúcar queimada, expõem os trabalhadores a diversos riscos, com variados impactos à saúde. A redução de riscos com exposição à poluição e sobrecarga térmica e física se impõe como medida para preservação da saúde do trabalhador.

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ABSTRACT OBJECTIVE Describe the main work risks for sugarcane cutters and their effects on workers’ health. METHODS Critical review of articles, with bibliographic research carried out in the PubMed, SciELO Medline, and Lilacs databases. The following keywords were used: sugarcane workers, sugarcane cutters, sugarcane harvesting, cortadores de cana-de-açú car , and colheita de cana -de-açúcar . The inclusion criteria were articles published between January 1997 and June 2017, which evaluated working conditions and health effects on sugarcane cutters. Those that did not deal with the work impact of cutting burned and unburnt sugarcane in the cutter’s health were excluded. The final group of manuscripts was selected by the lead author of this study and reviewed by a co-author. Disagreements were resolved by consensus using the predefined inclusion and exclusion criteria and, where necessary, the final decision was made by consulting a third co-author. RESULTS From the 89 articles found, 52 met the selection criteria and were evaluated. Studies have shown that cutters work under conditions of physical and mental overload, thermal overload, exposure to pollutants, and are subject to accidents. The main effects observed were respiratory, cardiovascular, renal, musculoskeletal, heat stress, dehydration, genotoxic, and those due to accidents. CONCLUSIONS Work on the manual cutting of sugarcane, especially of burned sugarcane, exposes workers to various risks, with different health impacts. Risk reduction for exposure to pollution and thermal and physical overload is required as a measure to preserve the health of the worker.

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ABSTRACT OBJECTIVE To estimate the proportion of unmet need for personal assistance for basic and instrumental activities of daily life and to evaluate socioeconomic inequalities related to the unmet need among community-dwelling Brazilian older adults. METHODS This was a cross-sectional study with data from the last National Health Survey in Brazil. Unmet need was considered as the presence of at least one unmet need for basic or instrumental activities of daily life among individuals reporting the need for assistance. Logistic regression models were used to assess the correlates and probabilities of unmet need. RESULTS The proportion of unmet need was 18% and 7.1% for basic and instrumental activities of daily life, respectively. Unmet need was significantly related to living arrangements and socioeconomic status. Individuals in the first quintile of wealth status had about 50% higher probability of having an unmet need. A family member was the most prevalent type of caregiver. CONCLUSIONS Long-term care policy is needed to reduce the proportion of unmet need, especially among socioeconomically disadvantaged groups. Future studies should address the availability, training, and remuneration of caregivers, as those are an indispensable labor force in an aging society.

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ABSTRACT OBJECTIVE To describe urinary cotinine levels in tobacco farmers. METHODS A cross-sectional study was conducted in 2,570 tobacco farmers. All participants that reported green tobacco sickness in the week prior to the interview plus a subsample of 492 pesticide applicators were included. We collected urinary samples and information about sociodemographic, behavioral, dietary, occupational characteristics, and pesticide poisoning during their lifetime. Stratification by sex and smoking was performed and the Wilcoxon and Kruskal-Wallis non-parametrical tests were used to analyze cotinine means. RESULTS This study included 582 individuals. There was no difference in urinary cotinine means between green tobacco sickness symptomatic and asymptomatic individuals. Among non-smokers, having picked tobacco in the previous week was associated with higher cotinine means in both genders. Cotinine levels were higher on the first day of symptoms and reduced exponentially with each day in female non-smokers. Male non-smokers had higher levels on the second day and a more gradual reduction. The cotinine level rose up to 15 cigarettes/day of consumption. CONCLUSIONS The urinary cotinine measures exposure to nicotine up to its saturation point; while green tobacco sickness, affected by tolerance, indicates nicotine poisoning. Strategies to reduce nicotine exposure in tobacco production are needed. Mechanization could be an alternative, as long as it overcame the challenge of irregular terrain and did not affect the quality of the leaf. More studies are needed to evaluate the chronic effect of nicotine exposure.

Resumo em Português:

RESUMO OBJETIVO Determinar os fatores demográficos e de saúde relacionados com a síndrome da fragilidade em idosos. MÉTODOS Estudo quantitativo longitudinal, realizado com 262 idosos acima de 65 anos de ambos os sexos, que vivem no domicílio. A coleta das informações no Tempo 1 foi realizada entre outubro de 2007 e fevereiro de 2008, e no Tempo 2 entre julho e dezembro de 2013. Para a coleta das informações, foi utilizado o instrumento do perfil sociodemográfico, a Edmonton Frail Scale, o Mini Exame do Estado Mental, o número de quedas nos últimos 12 meses, o número de doenças autorreferidas e medicamentos, a Medida de Independência Funcional e a Escala de Lawton e Brody. A estatística descritiva foi utilizada para a análise de dados, na comparação das médias entre ambos os tempos, o Teste não paramétrico de Wilcoxon e o método de Equações de Estimação Generalizadas, considerado uma extensão dos Modelos Lineares Generalizados com p ≤ 0,05. RESULTADOS Dos 515 participantes, 262 completaram o seguimento, com predomínio do sexo feminino, idosos mais velhos, sem companheiro(a); houve aumento de idosos frágeis. Na análise Equações de Estimação Generalizadas, o escore da fragilidade teve relação com as variáveis sociodemográficas (aumento da idade, estado civil sem companheiro(a) e baixa escolaridade), e de saúde (maior número de doenças, medicamentos, queda e diminuição da capacidade funcional). Verificou-se associação com as variáveis idade (mais velhos), o estado conjugal (não ter companheiro), e perda da capacidade funcional. CONCLUSÕES A síndrome da fragilidade esteve associada ao aumento da idade, estar sem companheiro(a) e diminuição da capacidade funcional ao longo do tempo, sendo necessários investimentos para a prevenção dessa síndrome e promoção de um envelhecimento de qualidade.

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ABSTRACT OBJECTIVE To determine the demographic and health factors related to the frailty syndrome in older adults. METHODS This is a longitudinal quantitative study carried out with 262 older adults aged 65 years and older, of both sexes, living at home. Data collection was carried out in Period 1 between October 2007 and February 2008, and in Period 2 between July and December 2013. For data collection, we used the sociodemographic profile instrument, the Edmonton Frail Scale, the Mini-Mental State Examination, the number of falls in the last 12 months, the number of self-reported diseases and used drugs, the Functional Independence Measure, and the Lawton and Brody Scale. We used descriptive statistics for data analysis, in the comparison of the means between periods, the nonparametric Wilcoxon test, and the method of Generalized Estimating Equations, which is considered an extension of the Generalized Linear Models with p ≤ 0.05. RESULTS Of the 515 participants, 262 completed the follow-up, with a predominance of females, older individuals, and those who had no partner; there was an increase in frail older adults. In the Generalized Estimating Equations analysis, frailty score was related to sociodemographic (increase in age, no partner, and low education level) and health variables (more diseases, drugs, falls, and decrease in functional capacity). There was an association between the variables of age (older), marital status (no partner), and loss of functional capacity. CONCLUSIONS Frailty syndrome was associated with increasing age, having no partner, and decreased functional capacity over time, and investments are required to prevent this syndrome and promote quality in aging.

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RESUMO OBJETIVO Descrever o processo de adaptação transcultural do Patient-Doctor Relationship Questionnaire (PDRQ-9), além de comparar a concordância entre duas diferentes formas de aplicação. MÉTODOS Estudo transversal, com 133 usuários adultos de uma Unidade Básica de Saúde de Porto Alegre, RS. O PDRQ-9 foi respondido pelos participantes de maneira autoaplicada e por meio de entrevista. O instrumento também foi validado por entrevista, utilizando os dados de 628 participantes da Pesquisa de Avaliação do Programa Mais Médicos, um estudo transversal com amostra sistemática de Unidades Básicas de Saúde em todas as regiões do Brasil. Foram realizadas avaliações de equivalência semântica, conceitual e de itens, análise fatorial e avaliação da fidedignidade. RESULTADOS Todos os itens apresentaram carga fatorial > 0,5 nos diferentes métodos de aplicação e populações na análise fatorial. Foi encontrado alfa de Cronbach de 0,94 no método autoaplicado. A aplicação por meio de entrevista encontrou alfa de Cronbach de 0,95 e 0,94 nas duas amostras diferentes. A utilização do PDRQ-9 por meio de entrevista ou de maneira autoaplicada foi considerada equivalente. CONCLUSÕES A adaptação transcultural do PDRQ-9 no Brasil replicou a estrutura fatorial encontrada no estudo original, com alta consistência interna. O instrumento poderá ser utilizado como uma nova dimensão na avaliação da qualidade do cuidado em saúde em pesquisas clínicas, na avaliação de serviços e em saúde pública, na gestão em saúde e na formação profissional. Novos estudos poderão ampliar a avaliação de outras propriedades do instrumento, bem como seu comportamento em diferentes populações e contextos.

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ABSTRACT OBJECTIVE To describe the process of cross-cultural adaptation of the Patient-Doctor Relationship Questionnaire (PDRQ-9), as well as compare the agreement between two different types of application. METHODS This is a cross-sectional study with 133 adult users of a Primary Health Service in Porto Alegre, State of Rio Grande do Sul, Brazil. The PDRQ-9 was answered by the participants as a self-administered questionnaire and in an interview. The instrument was also validated by interview, using data from 628 participants of the Mais Médicos Program Evaluation Research, which is a cross-sectional study with a systematic sample of Primary Care Services in all regions of Brazil. We evaluated the semantic, conceptual, and item equivalence, as well as factor analysis and reliability. RESULTS All items presented factor loading > 0.5 in the different methods of application and populations in the factor analysis. We found Cronbach’s alpha of 0.94 in the self-administered method. We found Cronbach’s alpha of 0.95 and 0.94 in the two different samples in the interview application. The use of PDRQ-9 with an interview or self-administered was considered equivalent. CONCLUSIONS The cross-cultural adaptation of the PDRQ-9 in Brazil replicated the factorial structure found in the original study, with high internal consistency. The instrument can be used as a new dimension in the evaluation of the quality of health care in clinical research, in the evaluation of services and public health, in health management, and in professional training. Further studies can evaluate other properties of the instrument, as well as its behavior in different populations and contexts.

Resumo em Espanhol:

RESUMEN OBJETIVO Analizar la influencia del contexto socioeconómico de la comunidad sobre la desnutrición infantil crónica en Colombia. MÉTODOS Utilizando datos de la Encuesta Nacional de Demografía y Salud en Colombia en 2010, se estimaron modelos logísticos multinivel. La muestra final incluyó 11.448 niños menores de cinco años anidados en 3.528 comunidades. Además, se utilizó el Análisis de Componentes Principales usando correlaciones policóricas para la construcción de indicadores compuestos de riqueza, autonomía de la mujer y el uso y acceso al sistema de salud. RESULTADOS El nivel de riqueza promedio de la comunidad resultó significativa e independientemente asociado con la desnutrición crónica en la primera infancia, por encima y más allá del propio estatus socioeconómico del hogar. A nivel individual y del hogar, la probabilidad de desnutrición crónica fue mayor para niños de madres con bajos niveles de autonomía y uso y acceso al sistema de salud, que han tenido su primer hijo en la adolescencia y que viven en hogares en los quintiles más bajos de riqueza. En contraste, niños de madres con un índice de masa corporal > 25 y con al menos educación secundaria (versus sin educación) tuvieron menor probabilidad de padecer desnutrición crónica. CONCLUSIONES Investigaciones, programas e intervenciones que tengan en cuenta el contexto físico, económico y social de las comunidades son necesarias para contribuir a mejorar el estado nutricional de la primera infancia en Colombia.

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ABSTRACT OBJECTIVE To analyze the influence of the socioeconomic context of the community on chronic child malnutrition in Colombia. METHODS We estimated multilevel logistic models using data from the National Demographic and Health Survey in Colombia in 2010. The final sample included 11,448 children under the age of five gathered in 3,528 communities. In addition, we used the Principal Component Analysis with polychoric correlations for the construction of composed indicators of wealth, autonomy of the woman, and the use and access to the health system. RESULTS The average level of community wealth was significantly and independently associated with chronic malnutrition in early childhood, more than the socioeconomic status of the household itself. At the individual and household level, the probability of chronic malnutrition was higher for children from mothers with low levels of autonomy and use and access to the health system, mothers who had their first child in adolescence, and mothers who live in homes in the lowest wealth quintiles. In contrast, children from mothers with a body mass index > 25 and with at least secondary education (versus no education) were less likely to suffer from chronic malnutrition. CONCLUSIONS Research, programs, and interventions need to take into account the physical, economic, and social context of communities to contribute with the improvement of the nutritional status of early childhood in Colombia.

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ABSTRACT OBJECTIVE To analyze if the burden of ischemic heart disease mortality trend attributed to physical inactivity in Brazil differs from the global estimates. METHODS Databases from the Global Burden of Disease Study for Brazil, Brazilian states, and global information were used. We estimated the summary exposure value for physical inactivity, the total number of deaths, and the age-standardized death rates for ischemic heart disease attributed to physical inactivity in the years 1990 and 2015, and the population-attributable fraction. Data were presented according to sex. RESULTS The Brazilian population was found to have a risk of exposure to physical inactivity varying between 70.4% for men and 75.7% for women in the year of 1990. This risk of exposure was similar in 2015. In men, the mortality rate from ischemic heart disease attributed to physical inactivity decreased in 2015 by approximately 24% around the world and 45% in Brazil. For women, this decrease was in 31% around the world and 45% in Brazil. The states of Southern and Southeastern Brazil presented lower mortality rates due to ischemic heart disease attributed to physical inactivity. If physical inactivity were eliminated in Brazil, mortality from ischemic heart disease would be reduced by 15.8% for men and 15.2% for women. CONCLUSIONS Over 25 years, the risk of exposure to physical inactivity in Brazil did not change and was high compared to global estimates. The decrease in ischemic heart disease mortality results from the improvement of health services in Brazil and the control of other risk factors. Approximately 15% of deaths from ischemic heart disease in Brazil could be avoided if people met the recommendations for physical activity.

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RESUMEN OBJETIVO Analizar las implicaciones de la atención de la población desplazada por violencia para el sistema de salud y los retos que le implica. MÉTODOS Revisión narrativa de literatura nacional e internacional en PubMed, SciELO, WHO/OPS, y Bireme. Los criterios de inclusión fueron, la fecha de publicación (a partir de 2000), la relación con el tema, y el idioma (español o inglés). Se encontraron 292 documentos, de los cuales 91 cumplían con los criterios de inclusión. RESULTADOS Los principales retos se referirán: al enfoque integral (con énfasis en la salud mental y la salud sexual y reproductiva), intersectorial, y participativo; a la garantía de la accesibilidad a los servicios de salud; a la necesidad de un sistema de información y registro confiable de la población desplazada por violencia y sus características; y al abordaje de las problemáticas biopsicosociales de los diferentes grupos, especialmente mujeres, personas con discapacidad o con enfermedades infecciosas, de adolescentes, niños y niñas, minorías étnicas, población adulta mayor y la población lésbica, gay, transexual, bisexual y intersexual. CONCLUSIONES La ausencia de voluntad política para la aceptación y visibilización del desplazamiento interno por violencia y de su importancia como problema humanitario y de salud pública, constituye un obstáculo para atender a la población desplazada por violencia de forma adecuada y oportuna en México.

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ABSTRACT OBJECTIVE To analyze the impacts of the care to the population displaced by violence on the health system and the challenges that this entails. METHODS This is a narrative review of the national and international literature in PubMed, SciELO, WHO/PAHO, and Bireme. Inclusion criteria were date of publication (from 2000), relation with the subject, and language (Spanish or English). We found 292 documents, of which 91 met the inclusion criteria. RESULTS The main challenges are the intersectoral, participatory, and integral approach (with emphasis on mental health and sexual and reproductive health), ensured accessibility to health services, the need for a reliable registration and information system of the population displaced by violence and its characteristics, and the addressing of the biopsychosocial problems of the different groups, especially women, persons with disabilities or infectious diseases, adolescents, children, ethnic minorities, older adults and the lesbian, gay, bisexual, transsexual, and intersexual population. CONCLUSIONS The lack of political will to accept and see the internal displacement by violence and its importance as a humanitarian and public health problem is an obstacle to the adequate and timely care of the population displaced by violence in Mexico.

Resumo em Português:

RESUMO OBJETIVO Avaliar a ouvidoria ativa em saúde como ferramenta de avaliação da qualidade da atenção ao parto e nascimento da Rede Cegonha do Distrito Federal. MÉTODOS Estudo transversal, do tipo inquérito por via telefônica, em 1.007 puérperas com partos realizados entre 15/10/2013 e 19/11/2013, nas 12 maternidades públicas que compõem a Rede Cegonha no Distrito Federal. O instrumento continha 25 questões de múltipla escolha ou do tipo escala Likert, que incluiu dados sociodemográficos e avaliação da aceitabilidade em cinco domínios: acessibilidade, relacionamento entre o paciente e os profissionais de saúde, condições da estrutura do serviço, informação ao paciente, e equidade e opinião do paciente. Variáveis qualitativas ou categóricas foram estudadas de acordo com a frequência e distribuição de proporções. Utilizou-se o escore transformado para uma escala de zero a 100 para análise das questões do tipo escala Likert. Resultados foram expressos em média e desvio-padrão. RESULTADOS O acesso às consultas de pré-natal foi avaliado como bom ou ótimo por 86,1% das participantes e os exames laboratoriais como bom ou ótimo por 85,2%. O acesso aos exames de imagem teve 45,7% avaliações boas ou ótimas; 79,5% das entrevistadas realizaram o parto na maternidade onde buscaram atendimento inicial e 18,3% receberam visita domiciliar por agente comunitário de saúde após a alta. A maioria relatou que os recém-nascidos foram colocados em seus colos ou peitos imediatamente após o nascimento, 48,9% tiveram presença de acompanhante no momento do parto, 76,3% foram orientadas em relação à primeira consulta dos recém-nascidos e 94,8% sobre aleitamento materno na maternidade. Quanto à avaliação dos profissionais de saúde, 85,9% das mulheres consideraram o acolhimento e a cordialidade recebidos como bons ou ótimos no pré-natal e 94,8%, como bons ou ótimos na maternidade. CONCLUSÕES A ouvidoria ativa em saúde contribuiu para a avaliação da qualidade da gestão pública, possibilitando a incorporação da perspectiva das usuárias do serviço de saúde na avaliação da aceitabilidade da Rede Cegonha no Distrito Federal.

Resumo em Inglês:

ABSTRACT OBJECTIVE To evaluate the active health Ombudsman service as an instrument to evaluate the quality of delivery and birth care in the Cegonha Network of the Federal District of Brazil. METHODS This is a cross-sectional study of the telephone survey type carried out with 1,007 mothers with deliveries between October 15, 2013 and November 19, 2013 in the twelve public maternity hospitals that make up the Cegonha Network of the Federal District of Brazil. The instrument has 25 multiple choice or Likert scale questions, including sociodemographic data and acceptability evaluation in five domains: accessibility, relationship between the patient and health professionals, conditions of the structure of the service, information to the patient, and equity and opinion of the patient. We have studied qualitative or categorical variables according to the frequency and distribution of proportions. We have used the score transformed into a scale from zero to 100 for the analysis of the Likert-type scale questions. Results have been expressed as mean and standard deviation. RESULTS Access to prenatal appointments was evaluated as good or excellent by 86.1% of the participants and laboratory tests was evaluated as good or excellent by 85.2% of them. The access to imaging tests was evaluations as good or excellent by 45.7% of the women; 79.5% of the interviewees had their delivery in the maternity hospital where they sought initial care and 18.3% received a home visit by a community health agent after discharge. Most women reported that newborns were placed skin-to-skin immediately after birth, 48.9% had a companion at the time of the delivery, 76.3% were advised about the first appointment of the newborn, and 94.8% were advised on breastfeeding in the maternity hospital. Regarding the evaluation of health professionals, 85.9% of the women considered reception and cordiality as good or excellent at the prenatal care and 94.8% considered it as good or excellent at the maternity hospital. CONCLUSIONS The active health Ombudsman service has contributed to evaluate the quality of public management by allowing the incorporation of the perspective of users of the health service in the evaluation of the acceptability of the Cegonha Network in the Federal District of Brazil.

Resumo em Espanhol:

RESUMEN OBJETIVO Examinar el efecto de una intervención de promoción de actividad física durante el recreo en los niveles de actividad física, comportamientos sedentarios y adiposidad de los escolares de Colombia. MÉTODOS Tres colegios fueron asignados aleatoriamente a un grupo de intervención en Bogotá, Colombia en el 2013: Intervención (Módulo Activo Recreo Activo – MARA)+Mensajes de Texto (SMS) (grupo MARA+SMS), intervención (grupo MARA), control (grupo de control). La intervención se implementó durante 10 semanas. La duración e intensidad de actividad física y comportamientos sedentarios se midieron objetivamente usando acelerómetros Actigraph-GT3X+. La adiposidad se midió mediante índice de masa corporal y porcentaje de grasa. Se realizaron mediciones en línea de base (T0) y durante la décima semana de intervención (T1). El efecto de la intervención se evaluó utilizando un análisis de diferencia-en-diferencias (ADD). RESULTADOS Fueron incluidos 120 escolares (57,5% niñas; edad promedio = 10,5 años; desviación estándar [DE] = 0,64). Hubo un aumento significativo en el promedio diario de minutos de actividad física moderada-vigorosa en el grupo MARA (Diferencia T1-T0 = 6,1 minutos; error estándar [EE] = 3,49; p = 0,005) con respecto al grupo de control. No se observaron cambios significativos en los minutos de actividad física moderada-vigorosa en el grupo MARA+SMS (Diferencia T1-T0 = -1,0 minuto; EE = 3,06; p = 0,363). En el grupo de control los minutos disminuyeron (Diferencia T1-T0 = -7,7 minutos; EE = 3,15; p = 0,011). Los minutos de comportamientos sedentarios disminuyeron en los grupos MARA y MARA+SMS y aumentaron en el grupo de control (MARA Diferencia T1-T0 = -15,8 minutos; EE = 10,05; p = 0,279; MARA+SMS Diferencia T1-T0 =-11,5 minutos; EE = 8,80; p = 0,869; Control Diferencia T1-T0 = 10,9 minutos; EE = 9,07; p = 0,407). Se registró mayor participación en el grupo MARA respecto al grupo MARA+SMS (grupo MARA = 34,4%; grupo MARA+SMS = 12,1%). No hubo cambios significativos en adiposidad en las diez semanas según análisis de diferencia-en-diferencias (índice de masa corporal p: Δgrupo MARA+SMS versus Δgrupo de control = 0,945, Δgrupo MARA versus Δgrupo control = 0,847, Δgrupo MARA+SMS versus Δgrupo MARA = 0,990; PG p Δgrupo MARA+SMS versus Δgrupo control = 0,788, Δgrupo MARA versus Δgrupo control = 0,915, Δgrupo MARA+SMS versus Δgrupo MARA = 0,975). CONCLUSIONES El Módulo Activo Recreo Activo es una estrategia prometedora para incrementar los niveles de actividad física y disminuir comportamientos sedentarios en escolares. Adicionar Mensajes de Texto no se asoció con incremento de actividad física moderada-vigorosa o en cambios en adiposidad.

Resumo em Inglês:

ABSTRACT OBJECTIVE To examine the effect of the promotion of physical activity during recess on the levels of physical activity, sedentary behaviors, and adiposity of Colombian students. METHODS Three schools were randomly selected by an intervention group in Bogotá, Colombia, in 2013: Intervention (Active Module of Active Recess – MARA) + Text Messages (SMS) (MARA+SMS group), intervention (MARA group), control (control group). Intervention was implemented for ten weeks. The duration and intensity of physical activity and sedentary behaviors were measured objectively using accelerometers Actigraph-GT3X+. Adiposity was measured by body mass index and fat percentage. We measured at baseline (T0) and during the tenth week of intervention (T1). We evaluated the effect of the intervention using a difference-in-difference analysis (DID). RESULTS We included 120 students (57.5% girls; mean age = 10.5 years; standard deviation [SD] = 0.64). There was a significant increase in the mean daily minutes of moderate to vigorous physical activity in the MARA group (Difference T1-T0 = 6.1 minutes, standard error [SE] = 3.49, p = 0.005) in relation to the control group. There were no significant changes in the minutes of moderate to vigorous physical activity in the MARA+SMS group (Difference T1-T0 = -1.0 minute; SE = 3.06; p = 0.363). The minutes decreased in the control group (Difference T1-T0 = -7.7 minutes; SE = 3.15; p = 0.011). The minutes of sedentary behaviors decreased in the MARA and MARA+SMS groups and increased in the control group (MARA Difference T1-T0 = -15.8 minutes; SE = 10.05; p= 0.279; MARA+SMS Difference T1-T0 = -11.5 minutes; SE = 8.80; p= 0.869; Control Difference T1-T0 = 10.9 minutes; SE = 9.07; p = 0.407). There was a higher participation in the MARA group in relation to the MARA+SMS group (MARA group = 34.4%; MARA+SMS group = 12.1%). There were no significant changes in adiposity at 10 weeks according to difference-in-differences analysis (body mass index p: ΔMARA+SMS group versus Δcontrol group = 0.945, ΔMARA group versus Δcontrol group = 0.847, ΔMARA+SMS group versus ΔMARA group = 0.990; FP p ΔMARA+SMS group versus Δcontrol group = 0.788, ΔMARA group versus Δcontrol group = 0.915, ΔMARA+SMS group versus ΔMARA group = 0.975). CONCLUSIONS The Active Module of Active Recess is a promising strategy to increase physical activity levels and decrease sedentary behavior in students. The addition of Text Messages was not associated with increased moderate to vigorous physical activity or changes in adiposity.

Resumo em Português:

RESUMO OBJETIVO Descrever a taxa de internação por condição sensível à atenção primária à saúde em grupos de municípios conforme o porte populacional e analisar sua associação com a cobertura pela Estratégia Saúde da Família após a implantação do Plano Diretor da Atenção Primária à Saúde em Minas Gerais. MÉTODOS Estudo ecológico com agrupamento de 452 municípios segundo o porte populacional, comparando dados de 2004 a 2007 e 2010 a 2013. O teste de Kolmogorov Smirnov foi utilizado para verificar a distribuição dos dados nos grupos. O teste de Wilcoxon para dados pareados ou teste t Student pareado foi usado para comparação da taxa de internação por condição sensível à atenção primária à saúde antes e após o Plano Diretor da Atenção Primária à Saúde. O teste de regressão linear simples foi utilizado para analisar a associação entre as variáveis. Foram realizadas análises estatísticas pelo Statistical Package for the Social Sciences, com nível de significância de 5%. RESULTADOS A taxa de internação por condição sensível à atenção primária à saúde diminuiu significativamente após o Plano Diretor da Atenção Primária à Saúde no grupo com grande e médio porte populacional (p < 0,05). Houve correlações positivas entre a cobertura com Estratégia Saúde da Família e a taxa de internação por condição sensível à atenção primária à saúde nos grupos com porte populacional médio e grande (p < 0,05). CONCLUSÕES Foram empreendidos esforços com a implantação do Plano Diretor da Atenção Primária à Saúde. Entretanto, é preciso que mais investimentos sejam realizados para contribuir para a melhoria da efetividade da Atenção Primária à Saúde, com enfrentamento permanente de questões complexas que incidem sobre a qualidade dos serviços, gerando redução significativa das taxas de internação por condição sensível à atenção primária à saúde.

Resumo em Inglês:

ABSTRACT OBJECTIVE To describe the rate of ambulatory care sensitive hospitalizations in groups of cities according to population size and to analyze its association with the coverage of the Family Health Strategy after the implementation of the Master Plan for Primary Health Care in Minas Gerais, Brazil. METHODS This is an ecological study with 452 cities grouped according to population size, with data from 2004 to 2007 and 2010 to 2013. We used the Kolmogorov-Smirnov test to verify the distribution of the data in the groups. We used the Wilcoxon test for paired data or the paired Student’s t-test to compare the rate of ambulatory care sensitive hospitalizations before and after the Master Plan for Primary Health Care. We used the simple linear regression test to analyze the association between variables. We performed statistical analyses using the Statistical Package for the Social Sciences, with a significance level of 5%. RESULTS The rate of ambulatory care sensitive hospitalizations decreased significantly after the Master Plan for Primary Health Care in the large and mid-sized groups (p < 0.05). There were positive correlations between coverage with Family Health Strategy and the rate of ambulatory care sensitive hospitalizations in the mid-sized and large groups (p < 0.05). CONCLUSIONS Actions were carried out to implement the Master Plan for Primary Health Care. However, more investments are needed to improve the effectiveness of the Primary Health Care, with permanent confrontation of complex issues that affect the quality of services, which can lead to a significant reduction of the rates of ambulatory care sensitive hospitalizations.

Resumo em Português:

RESUMO OBJETIVO Analisar a validade e a confiabilidade teste-reteste da versão brasileira do questionário holandês “Expectativas sobre o trabalho”. MÉTODOS Foram utilizados os dados de um estudo longitudinal conduzido na cidade de São Paulo, SP, entre 2014 e 2016. Participaram 411 trabalhadores afastados do trabalho por mais de 15 dias devido a transtornos mentais. Uma subamostra de 126 participantes respondeu ao questionário pela segunda vez, com intervalo de sete a 21 dias. Foram analisadas a validade fatorial e concorrente, e a confiabilidade teste-reteste. RESULTADOS A maioria dos participantes era do sexo feminino (71,5%), com média de idade de 36,7 anos; 83,1% tinham escolaridade igual ou superior a 12 anos de estudo e o tempo médio de afastamento foi de 84 dias. O valor de autoeficácia médio inclinava-se para valores abaixo do ponto médio da escala. A estrutura fatorial apresentou-se como bidimensional e a validade concorrente confirmou o constructo original. A confiabilidade teste-reteste de cada item, ajustada pela prevalência, variou de boa (0,70) a quase perfeita (0,83). CONCLUSÕES Embora a estrutura bidimensional fosse diferente da original, outros parâmetros mostraram-se adequados. O uso do questionário “Expectativa sobre o trabalho” entre trabalhadores do Brasil pode auxiliar no planejamento de processos de retorno ao trabalho. Novos estudos devem ser desenvolvidos para complementar a análise do uso da ferramenta no Brasil.

Resumo em Inglês:

ABSTRACT OBJECTIVE To investigate the validity and test-retest reliability of the Brazilian version of the Dutch questionnaire “Verwachtingen over werken”. METHODS We analyzed data from a longitudinal study conducted in the city of São Paulo, Brazil, from 2014 to 2016. Participants were 411 workers on sick leave for more than 15 days due to mental disorders. A subsample of 126 participants responded the questionnaire a second time, seven to 21 days later. Factorial and concurrent validities and the test-retest reliability were analyzed. RESULTS Most participants were female (71.5%), the average age was 36.7 years; 83.1% had attended 12 or more years of formal schooling; the average length of sick leave was 84 days. The average self-efficacy score tended to be below the scale midpoint. The construct had a two-dimensional structure and the concurrent validity confirmed the original construct. For all items, the test-retest reliability adjusted for prevalence ranged from good (0.70) to almost perfect (0.83). CONCLUSIONS While the two-dimensional structure diverges from the original, other parameters were adequate. Application of the Return-to-work self-efficacy questionnaire to Brazilian workers might contribute to the planning of return-to-work process. Additional studies are needed to complement the analysis of the use of this instrument in Brazil.

Resumo em Português:

RESUMO A doença renal crônica apresenta elevada morbimortalidade. Com o objetivo de rastrear a doença, realizou-se estudo de base populacional em cidade de porte médio do sudeste brasileiro. Com base no instrumento SCreening for Occult REnal Disease (SCORED) foram avaliados 1.016 indivíduos com média de idade 44 (DP = 13,2) anos. Hipertensão arterial e diabetes mellitus, principais causas de doença renal crônica, foram relatados por 34,7% e 10,5%, respectivamente. Além disso, 31,3% da amostra apresentou risco aumentado para a doença, levando a uma estimativa de prevalência de 5,4%. Um método simples para rastreio permitiu a detecção precoce de população de risco para doença renal crônica.

Resumo em Inglês:

ABSTRACT Chronic kidney disease has high morbidity and mortality. In order to track the disease, we conducted a population-based study in a medium-sized city in Southeastern Brazil. Based on instrument SCreening for Occult REnal Disease (SCORED), we evaluated 1,016 individuals with mean age of 44 (SD = 13.2) years. High blood pressure and diabetes mellitus, major causes of chronic kidney disease, were reported by 34.7% and 10.5% of the individuals, respectively. In addition, 31.3% of the sample presented increased risk for the disease, thus leading to a prevalence estimate of 5.4%. A simple screening method allowed the early detection of a population at risk for chronic kidney disease.

Resumo em Português:

RESUMO OBJETIVO Avaliar fatores associados ao óbito hospitalar em idosos internados por doenças do aparelho circulatório específicas no Sistema Único de Saúde, considerando a mortalidade hospitalar ajustada como indicador de efetividade. MÉTODOS As informações foram extraídas do Sistema de Informações Hospitalares. Foram selecionadas 385.784 internações de idosos por doenças hipertensivas, doença isquêmica do coração, insuficiência cardíaca congestiva e doenças cerebrovasculares, na região Sudeste entre 2011 e 2012. Idade, sexo, admissão de emergência, diagnóstico principal e dois índices de comorbidade foram incluídos na regressão logística para o ajuste do risco de óbito. As análises foram desenvolvidas em dois níveis: internação e hospital. RESULTADOS Observou-se maior chance de morrer nas idades mais avançadas, nas internações de urgência, por doenças cerebrovasculares, com registro de comorbidade, especialmente pneumonia e perda de peso, nas internações para cuidado clínico e com uso de unidades de terapia intensiva. A taxa de mortalidade hospitalar ajustada foi 11,1% nos hospitais privados, 12,3% nos filantrópicos e 14,4% nos públicos, mas houve grande variabilidade entre hospitais. A razão de mortalidade hospitalar ajustada (razão entre óbitos observados e preditos) variou entre 103,3% nos hospitais filantrópicos e 118,2% nos hospitais privados. CONCLUSÕES Embora haja insuficiências na fonte de informação, a capacidade de discriminação do modelo de ajuste de risco mostrou-se razoável. A variabilidade na mortalidade hospitalar ajustada foi ampla e comparativamente maior nos hospitais privados. Apesar dos limites, os resultados favorecem o uso da mortalidade hospitalar ajustada por risco no monitoramento da qualidade do cuidado hospitalar prestado ao idoso.

Resumo em Inglês:

ABSTRACT OBJECTIVE To evaluate factors associated with hospital death in older inpatients for specific diseases of the circulatory system in the Brazilian Unified Health System considering the risk-adjusted hospital mortality as an indicator of effectiveness. METHODS The data were extracted from the Brazilian Hospital Information System. A total of 385,784 hospitalizations of older were selected for hypertensive diseases, ischemic heart disease, congestive heart failure, and stroke in the Brazilian Southeast region between 2011 and 2012. Age, sex, emergency admission, principal diagnosis, and two comorbidity indexes were included in the logistic regression for the risk adjustment of hospital death. The analyses were developed at two levels: hospitalization and hospital. RESULTS A greater chance of death was observed with increasing age, emergency hospitalizations, stroke, presence of comorbidities, especially pneumonia and weight loss, hospitalizations for clinical care, and use of intensive care units. The risk-adjusted hospital mortality rate was 11.1% in for-profit private hospitals, 12.3% in non-profit private hospitals, and 14.4% in public hospitals, but there was great variability among the hospitals. The hospital standardized mortality ratio (ratio between observed and predicted deaths) ranged from 103.3% in non-profit private hospitals to 118.2% in for-profit private hospitals. CONCLUSIONS Although the information source has its shortcomings, the ability for discrimination of the risk adjustment model was reasonable. The variability in the risk-adjusted hospital mortality was great and comparatively higher in for-profit private hospitals. Despite the limits, the results favor the use of the risk-adjusted hospital mortality in the monitoring of the quality of hospital care provided to the older adult.

Resumo em Português:

RESUMO OBJETIVO Investigar os fatores associados ao óbito domiciliar entre idosos que morreram por câncer em uma cidade de grande porte. MÉTODOS Estudo descritivo, incluindo todos os óbitos por câncer (CID C00-C97) ocorridos entre 2006 e 2012, entre residentes do município de São Paulo com 60 anos de idade ou mais. A fonte de dados foi o Sistema de Informações de Mortalidade e a proporção de óbitos foi estimada segundo local, sexo, faixa etária, raça/cor, escolaridade, estado civil, tipo de câncer, disponibilidade de leitos hospitalares e ano do óbito. O teste qui-quadrado foi utilizado para investigar as associações entre o local do óbito e as variáveis sociodemográficas e clínicas. A regressão logística foi empregada para identificar fatores associados à morte domiciliar. Foram estimadas as razões de chance brutas e ajustadas e os intervalos de confiança de 95%. RESULTADOS A maioria dos óbitos ocorreu em hospitais (88,2%). Houve associação significativa entre o local de óbito e as seguintes variáveis: sexo, raça/cor, escolaridade, faixa etária, estado civil, tipo de câncer, disponibilidade de leitos hospitalares e ano do óbito. Na análise multivariada, todas as variáveis, exceto a disponibilidade de leitos hospitalares, permaneceram como preditores independentes de óbito domiciliar. CONCLUSÕES Houve predomínio de óbitos hospitalares, com aumento na frequência no período. O sexo feminino, maior escolaridade, o status de casado ou viúvo e a raça negra foram associados à menor chance de óbito domiciliar, enquanto o aumento da idade, a raça/cor amarela e as neoplasias sólidas estiveram associados à maior chance de morrer em casa.

Resumo em Inglês:

ABSTRACT OBJECTIVE Investigate factors associated with death at home among older adults who died of cancer in a large city. METHODS This is a descriptive study, including all cancer deaths (ICD C00-C97) occurring between 2006 and 2012, among residents of the city of São Paulo, 60 years of age or older. The data source was the Mortality Information System, and the proportion of deaths was calculated according to place of occurrence, gender, age, race/skin color, education, marital status, cancer type, hospital bed availability, and year of death. The chi-squared test was used to examine the associations between the place of death and sociodemographic and clinical variables. Logistic regression was used to identify factors associated with home death. Crude and adjusted odds ratios and the corresponding 95% confidence intervals were estimated. RESULTS Most of the deaths occurred in hospitals (88.2%). There was a significant association between the place of death and the following variables: gender, race/skin color, education, age, marital status, cancer type, hospital bed availability, and year of death. In the multivariate analysis, all variables, except the availability of hospital beds, remained as independent predictors of death at home. CONCLUSIONS There was a predominance of hospital deaths, with an increase in frequency in the period. Female gender, higher education, married or widowed status, and black race were associated with a decreased risk of death at home, while increasing age, Asian race, and solid neoplasms were associated with higher risk of dying at home.

Resumo em Espanhol:

RESUMEN OBJETIVO Analizar el avance de la meta esperada a mitad del Decenio de Acción para la Seguridad Vial 2011–2020 en México y sus entidades federativas. MÉTODOS Análisis secundario de las muertes por accidentes de tránsito en México para el 1999–2015. Se proyectó la tendencia para el periodo 2011–2020 utilizando análisis de series de tiempo (modelos autorregresivos integrados de medias móviles). Se utilizó el valor del Criterio de Información de Aikaike para determinar el mejor modelo para el nivel nacional y sus 32 entidades federativas. RESULTADOS México va avanzando cercano a la meta propuesta, lo que se ha traducido en 10,856 defunciones potencialmente prevenidas en el quinquenio 2011 a 2015. Esto ha sido a expensas de una disminución en el número de muertes de ocupantes de vehículos de motor; ya que las muertes en peatones y motociclistas han ido por arriba de lo que se esperaba. Al menos una tercera parte de las entidades federativas tuvo el número de defunciones por debajo de su meta; aunque en cinco de ellas la tasa de mortalidad continúa inaceptablemente alta. Se identificaron cuatro entidades con más muertes que las proyectadas originalmente y otras con tendencia al incremento donde se requiere, para ambos casos, fortalecer las acciones de prevención. CONCLUSIONES El análisis realizado permite observar los avances del país a mitad del Decenio de Acción, así como identificar los retos en materia de prevención de lesiones causadas por el tránsito en usuarios vulnerables. Aporta elementos para soportar la necesidad de replantear tanto la meta nacional como la de las distintas entidades federativas.

Resumo em Inglês:

ABSTRACT OBJECTIVE To analyze the progress towards the accomplishment of the expected goal in the middle of the Decade of Action for Road Safety 2011–2020 in Mexico and its states. METHODS This is a secondary analysis of road traffic deaths in Mexico between 1999 and 2015. We projected the trend for the period 2011–2020 using a time series analysis (autoregressive integrated moving average models). We used the value of the Aikaike Information Criterion to determine the best model for the national level and its 32 states. RESULTS Mexico is progressing, approaching the proposed goal, which translates into 10,856 potentially prevented deaths in the five-year period from 2011 to 2015. This was due to a decrease in the number of deaths of motor vehicle occupants, as the deaths of pedestrians and motorcyclists were higher than expected. At least one third of the states had values below their goal; although the mortality rate remains unacceptably high in five of them. We identified four states with more deaths than those originally projected and other states with an increasing trend; thus, both cases need to strengthen their prevention actions. CONCLUSIONS The analysis can allow us to see the progress of the country in the middle of the Decade of Action, as well as identify the challenges in the prevention of traffic injuries in vulnerable users. It contributes with elements that provide a basis for a need to rethink both the national goal and the goal of the different states.

Resumo em Português:

RESUMO OBJETIVO Estimar a prevalência do HIV e descrever os incentivos e barreiras à realização do teste para o HIV entre mulheres profissionais do sexo. MÉTODOS Este estudo transversal recrutou 402 mulheres de 18 anos ou mais, residentes em Fortaleza, CE, que informaram ter tido relação sexual em troca de dinheiro nos últimos quatro meses. A amostra foi recrutada por meio da técnica Respondent Driven Sampling, entre agosto e novembro de 2010. RESULTADOS A adesão ao teste de HIV foi de 84,1% e a prevalência estimada da infecção pelo HIV foi de 3,8%. A amostra era jovem (25 a 39 anos), solteira (80,0%), com um a três filhos (83,6 %), tinham oito anos ou mais de estudo (65,7%) e pertencia às classes sociais D/E (53,1%). A maioria exercia a profissão em locais fechados (bares, motéis, hotéis, sauna – 88,9%), e a prostituição era a única fonte de renda (54,1%). Cerca de 25% da amostra desconhecia onde o teste de HIV era realizado na rede pública e 51,8% nunca fez o teste ou se testou há um ano ou mais. As principais barreiras ao teste foram acreditar que não corre risco de se infectar (24,1%) e o medo da discriminação caso o teste fosse reagente (20,5%). Os incentivos foram relacionados à maior oferta de locais para o teste (57,0%) e de unidades de saúde com horários alternativos (44,2%). CONCLUSÕES A prevalência foi semelhante à encontrada em outras cidades brasileiras de diferentes regiões do país, apesar de superiores a de mulheres não profissionais do sexo. A disponibilidade do teste em locais não relacionados à saúde e a oferta nas unidades básicas em horário não comercial são fatores que incentivam a realização do teste. Não se considerar sob-risco, medo de ser discriminada e desconhecimento dos locais onde o teste é realizado podem ser uma barreira para a realização do exame.

Resumo em Inglês:

ABSTRACT OBJECTIVE Estimating HIV prevalence and describing the incentives and barriers for HIV testing among female sex workers. METHODS This cross-sectional study recruited 402 women aged 18 years or older, residing in Fortaleza, state of Ceará, Brazil, who reported having had sexual intercourse in exchange for money in last four months. The sample was recruited using Respondent Driven Sampling, between August and November 2010. RESULTS The 84.1% of the sample tested and the estimated prevalence of HIV infection was 3.8%. The sample was young (25 to 39 years ), single (80.0%), with one to three children (83.6%), had eight or more years of schooling (65.7%), and belonged to social classes D/E (53.1%). The majority worked in fixed locations (bars, motels, hotels, sauna - 88.9%), and prostitution was their only source of income (54.1%). About 25% of the sample did not know where to test in the public health sector and 51.8% either never tested or hadn’t tested for over a year or more. The main reported barriers to testing were the perceptions that there was no risk of becoming infected (24.1%), and, alternatively, fear of discrimination if the test was positive (20.5%). Incentives for testing were the greater availability of testing sites (57.0%) and health facilities with alternative schedules (44.2%). CONCLUSIONS Prevalence for HIV was similar to that found in other Brazilian cities in different regions of the country, although higher than the general female population. Non-traditional venues not associated with the health system and availability of testing in health units during non-commercial hours are factors that encourage testing. Not considering oneself to be at risk, fear of being discriminated against and not knowing testing locations are barriers.

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ABSTRACT OBJECTIVE An ecological study describring the spatial characteristics of AIDS in São Paulo city between 2001 and 2010 according to the place of residence of reported cases in adults. METHODS The AIDS reported cases (28,146), grouped by sex, were geocodified (25,969) and linked with a census tract database (18,953). Case and population at risk data supplied spatial cluster identification and relative risk estimate by the scan method, using the discrete Poisson model. Incidence rate and proportional distribution allowed comparing people living in the high-risk clusters areas to other locations by age, race/ethnicity, schooling and transmission category. RESULTS The AIDS incidence rate decreased in both sexes except among young men and older people. The identification of spatial high-risk clusters showed that the decrease of AIDS did not occur in the same way in the city. Clusters located in the central area presented the highest AIDS incidence rates (245.7/100,000 men), especially among black women (RR = 7.9), men who have sex with men (66.2%) and injection drug users (10.7%) participation. In peripheral clusters, identified only in the female population, the epidemic can be related to the poverty of these women (22.5% low education level). Residents in the north and central-south areas of the city are generally black, with little schooling, and predominantly heterosexually infected. CONCLUSIONS The study of spatial clusters using a census tract helps to determine epidemiological patterns inside the city and in specific populations. Spatial stratification and key population epidemiological patterns were identified in four regions in São Paulo city.

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RESUMO OBJETIVO Apresentar o desenvolvimento e a validação do Questionário WebAd-Q, um instrumento de autorrelato para monitorar a adesão à terapia antirretroviral em serviços de HIV/Aids no Brasil. MÉTODOS O WebAd-Q é um questionário eletrônico que contém três perguntas sobre a tomada dos antirretrovirais na última semana. Foi construído a partir de entrevistas e grupos focais com 38 pacientes. Sua validade foi testada em estudo com uma amostra de 90 pacientes maiores de 18 anos, sob terapia antirretroviral há pelo menos três meses. Foram utilizadas as seguintes medidas de adesão comparativas: monitoramento eletrônico, contagem de pílulas e entrevista de autorrelato. O WebAd-Q foi respondido no sexagésimo dia por duas vezes, com intervalo mínimo de uma hora. A carga viral dos pacientes foi obtida nos registros do serviço. Analisamos a concordância entre as respostas ao WebAd-Q, associações e correlações com a carga viral e o desempenho em comparação às demais medidas de adesão. RESULTADOS Entre os pacientes convidados, 74 (82,2%) responderam ao WebAd-Q. Não foram relatadas dificuldades em responder ao questionário. O tempo médio de resposta foi de 5 min 47 seg. O conjunto das três questões do WebAd-Q obteve concordância de 89,8%, com Kappa de 0,77 (IC95% 0,61–0,94). As respostas de não adesão do WebAd-Q associaram-se à carga viral detectável. Foram obtidas correlações moderadas da carga viral com escala de não adesão segundo o WebAd-Q. Para as três perguntas do WebAd-Q, pacientes com respostas de não adesão foram também apontados como menos aderentes segundo as demais medidas de adesão. CONCLUSÕES O WebAd-Q atendeu a todos os quesitos considerados relevantes na validação de questionários, foi bem entendido por pacientes, apresentou associação com a carga viral e obteve boa concordância e bom desempenho em comparação a medidas concorrentes. A análise da viabilidade de sua implementação ainda depende de um estudo nacional de aplicabilidade.

Resumo em Inglês:

ABSTRACT OBJECTIVE To present the development and validation of the WebAd-Q Questionnaire, a self-report instrument to monitor adherence to antiretroviral therapy in HIV/AIDS centers in Brazil. METHODS The WebAd-Q is an electronic questionnaire that has three questions about the use of antiretrovirals in the last week. It was constructed from interviews and focus groups with 38 patients. Its validity was tested in a study with a sample of 90 adult patients on antiretroviral therapy for at least three months. We used electronic monitoring bottles, pill counting, and self-report interview to compare adherence. The WebAd-Q was answered on the sixtieth day, twice, with at least one hour of interval. The viral load of the patients was obtained from the service records. We have analyzed the agreement between the answers to the WebAd-Q, the associations, and the correlations with viral load and performance compared to other measures of adherence. RESULTS Among the invited patients, 74 (82.2%) answered the WebAd-Q. No difficulties were reported to answer the questionnaire. The average answer time was 5 min 47 sec. The set of three questions of the WebAd-Q obtained agreement of 89.8%, with Kappa of 0.77 (95%CI 0.61–0.94). The non-adherence answers of the WebAd-Q were associated with detectable viral load. We obtained moderate viral load correlations with the non-adherence scale according to the WebAd-Q. For the three questions of the WebAd-Q, patients with non-adherence answers were also reported as less adherent according to the other measures of adherence. CONCLUSIONS The WebAd-Q answered all the issues considered relevant in the validation of questionnaires, was well understood by patients, was associated with viral load, and obtained good agreement and good performance compared to the other measures. The feasibility analysis of its implementation still depends on a national study on its applicability.

Resumo em Português:

RESUMO OBJETIVO Analisar a prevalência de não consultar com médico no período de um ano. MÉTODOS Estudo transversal de base populacional, incluindo mulheres de 20 a 60 anos, residentes na zona urbana de São Leopoldo, RS, em 2015. A associação entre as variáveis e o desfecho foi avaliada por meio das razões de prevalência e dos intervalos de 95% de confiança (IC95%). A análise ajustada foi realizada por meio da regressão de Poisson com variância robusta. RESULTADOS Entre as 1.127 mulheres participantes do estudo, 954 (84,6%; IC95% 82,5–86,7) referiram consultar com médico no ano anterior à entrevista, 173 (15,4%; IC95% 13,2–17,5) não consultaram. As mulheres inseridas nas classes econômicas D e E, com menor idade, e fumantes apresentaram maiores prevalências de não consulta médica. As participantes com hipertensão arterial tiveram maior prevalência de consultas. CONCLUSÕES Não houve a esperada evolução no sistema local de saúde, apesar do surgimento das políticas implantadas nesse período. É necessário provimento da atenção para os indivíduos em condições socioeconômicas menos favorecidas e para as mulheres mais jovens.

Resumo em Inglês:

ABSTRACT OBJECTIVE To analyze the prevalence of not consulting a doctor within a year. METHODS Cross-sectional population-based study, including women aged 20–60 years, living in the urban area of São Leopoldo, state of Rio Grande do Sul, in 2015. The association between variables and outcome was assessed using prevalence ratios and 95% confidence intervals (95%CI). The adjusted analysis was performed using Poisson regression with robust variance. RESULTS Among the 1,127 women participating in the study, 954 (84.6%, 95%CI 82.5–86.7) reported having consulted a physician in the year prior to the interview, 173 (15.4%, 95%CI 13.2–17.5) did not. Women belonging to lower income classes D and E, younger, and smokers had higher prevalences of no medical visits. The participants with hypertension had a higher prevalence of consultations. CONCLUSIONS There was no expected evolution in the local health system, despite the emergence of the policies implemented in this period. It is necessary to provide care for those in less favored socioeconomic conditions and for younger women.

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ABSTRACT OBJECTIVE To assess the prevalence and correlates of insufficient physical activity in adolescents in Peru. METHODS We used a self-administered questionnaire developed from Global school-based Student Health Survey to collect information from secondary school students in North Lima and Callao in 2015. We carried out Poisson regression with robust variance using generalized linear models to estimate the crude and adjusted prevalence ratios (APR) with 95% confidence intervals (95%CI) of insufficient physical activity for its correlates. RESULTS We have found that 78% of the adolescents did not meet the global recommendation of the World Health Organization on physical activity in the last week before the survey. Female respondents (APR = 1.13, 95%CI 1.04–1.21), respondents who perceived themselves as overweight (APR = 1.10, 95%CI 1.03–1.18), and respondents who consumed insufficient vegetables and fruits [no vegetables (APR = 1.30, 95%CI 1.06–1.59), no fruits (APR = 1.15, 95%CI 1.00–1.31) as compared to those who consumed ≥ 2 servings every day in the last seven days] were more likely to report insufficient physical activity. Adolescents who worked after school (APR = 0.92, 95%CI 0.84–0.99), had physical education classes five times per week (APR = 0.94, 95%CI 0.88–0.99), and had parental supervision (APR = 0.92, 95%CI 0.87–0.98) were less likely to report insufficient physical activity. CONCLUSIONS Sex, work after school, perceived body weight, physical education class, parental support, and healthy dietary behaviors were associated with insufficient physical activity. Attempts to improve physical activity should look for ways to enhance leisure-time physical activity, parental support, physical education classes, healthy dietary behaviors, and normal body weight maintenance in adolescents with integrated efforts from the family and school.

Resumo em Português:

RESUMO OBJETIVO Avaliar a associação entre os serviços de saúde ofertados por equipes de atenção básica e a detecção de casos novos de tuberculose no Brasil. MÉTODOS Estudo ecológico, abrangendo todos os municípios brasileiros que registraram pelo menos um caso novo de tuberculose (diagnosticado entre 2012 a 2014 e notificado no Sistema de Informação de Agravos de Notificação) e com pelo menos uma equipe de atenção básica avaliada pelo segundo ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). As variáveis do PMAQ-AB foram classificadas como próximais ou distais, segundo a sua relação com o diagnóstico de tuberculose. Em seguida, foram testadas hierarquicamente em modelos múltiplos (ajustados por Unidade Federada), usando regressão binomial negativa. RESULTADOS Um incremento de 10% na cobertura da atenção básica esteve associado à redução de 2,24% na taxa de detecção de tuberculose (IC95% -3,35– -1,11). No que se refere às variáveis proximais ao diagnóstico, no modelo múltiplo, a detecção da tuberculose esteve associada à proporção de equipes que: realizam vigilância de contatos (incremento na Razão de Taxas de Incidência [RTI] = 2,97%; IC95% 2,41–3,53); fazem busca ativa de casos de tuberculose (incremento na RTI = 2,17%; IC95% 1,48–2,87); e, ofertam cultura para micobactérias (incremento na RTI = 1,87%; IC95% 0,98–2,76). CONCLUSÕES As variáveis relacionadas às ações de detecção estiveram positivamente associadas à detecção de casos novos de tuberculose, sugerindo uma contribuição significativa ao fortalecimento da sensibilidade do sistema de vigilância. Por outro lado, a cobertura da atenção básica esteve inversamente associada à taxa de detecção de tuberculose, o que poderia representar o efeito global da atenção básica sobre o controle da transmissão, provavelmente, através da identificação e tratamento precoce de casos.

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ABSTRACT OBJECTIVE To evaluate the association between the health services offered by primary care teams and the detection of new tuberculosis cases in Brazil. METHODS This was an ecological study covering all Brazilian municipalities that registered at least one new tuberculosis case (diagnosed between 2012 to 2014 and notified in the Information System of Notifiable Diseases) and with at least one primary care team evaluated by the second cycle of the National Program for Improving Access and Quality of Primary Care (PMAQ-AB). The variables of the PMAQ-AB were classified as proximal or distal, according to their relation with the tuberculosis diagnosis. Then, they were tested hierarchically in multiple models (adjusted by States) using negative binomial regression. RESULTS An increase of 10% in the primary health care coverage was associated with a decrease of 2.24% in the tuberculosis detection rate (95%CI -3.35– -1.11). Regarding the proximal variables in relation to diagnosis, in the multiple model, the detection of tuberculosis was associated with the proportion of teams that conduct contact investigation (increase in Incidence Rate Ratio [IRR] = 2.97%, 95%CI 2.41–3.53), carry out tuberculosis active case finding (increase in IRR = 2.17%, 95%CI 1.48–2.87), and request culture for mycobacteria (increase in IRR = 1.87%, 95%CI 0.98–2.76). CONCLUSIONS The variables related to the search actions were positively associated with the detection of new tuberculosis cases, which suggests a significant contribution to the strengthening of the sensitivity of the surveillance system. On the other hand, primary care coverage was inversely associated with the tuberculosis detection rate, which could represent the overall effect of the primary care on transmission control, probably from the identification and early treatment of cases.

Resumo em Português:

RESUMO OBJETIVO Caracterizar a aquisição domiciliar e o consumo alimentar individual de hortaliças no Brasil e analisar sua relação com o consumo de alimentos ultraprocessados. MÉTODOS Foram utilizados dados de aquisição de alimentos para consumo no domicílio e de consumo alimentar individual da Pesquisa de Orçamentos Familiares 2008–2009. A Pesquisa de Orçamentos Familiares estudou a aquisição de alimentos de 55.970 domicílios e o consumo alimentar de 34.003 indivíduos com 10 anos ou mais de idade. Os alimentos de interesse neste estudo foram as hortaliças (excluindo raízes e tubérculos) e os alimentos ultraprocessados. A quantidade de hortaliças (gramas) adquiridas e consumidas foi descrita para o conjunto dos brasileiros e segundo quintos da participação calórica de alimentos ultraprocessados na alimentação. Para tanto, foram calculados os valores brutos e preditos, obtidos por modelos de regressão ajustados por variáveis sociodemográficas. Analisaram-se os tipos mais adquiridos de hortaliças (% na quantidade total) e, em relação ao consumo alimentar individual, a variedade de hortaliças consumidas (número absoluto), a participação (%) dos tipos de preparação culinária à base de hortaliças e os horários de consumo. RESULTADOS A aquisição domiciliar média ajustada de hortaliças foi 42,9 g/per capita/dia. O consumo individual médio ajustado foi 46,1 g. Verificou-se relação inversa entre aquisição domiciliar e consumo individual de hortaliças e de alimentos ultraprocessados. Dez tipos de hortaliças respondem por mais de 80% da quantidade total habitualmente adquirida. A variedade consumida foi, em média, 1,08 tipo/per capita/dia. Cerca de 60% das hortaliças foram consumidas cruas, sendo a quantidade consumida no almoço duas vezes maior que aquela do jantar e indivíduos com maior consumo de alimentos ultraprocessados tenderam a consumir quantidade ainda menor de hortaliças no jantar. CONCLUSÕES O consumo de hortaliças no Brasil é insuficiente, sendo pior entre indivíduos com maior consumo de alimentos ultraprocessados. O hábito mais frequente foi consumir hortaliças cruas, no almoço e com limitada variedade.

Resumo em Inglês:

ABSTRACT OBJECTIVE To characterize the household purchase and the individual consumption of vegetables in Brazil and to analyze their relation with the consumption of ultra-processed foods. METHODS We have used data on the purchase of food for household consumption and individual consumption from the 2008–2009 Brazilian Household Budget Survey. The Brazilian Household Budget Survey studied the purchase of food of 55,970 households and the food consumption of 34,003 individuals aged 10 years and over. The foods of interest in this study were vegetables (excluding roots and tubers) and ultra-processed foods. We have described the amount of vegetables (grams) purchased and consumed by all Brazilians and according to the quintiles of caloric intake of ultra-processed food. To this end, we have calculated the crude and predicted values obtained by regression models adjusted for sociodemographic variables. We have analyzed the most commonly purchased types of vegetables (% in the total amount) and, in relation to individual food consumption, the variety of vegetables consumed (absolute number), the participation (%) of the types of culinary preparations based on vegetables, and the time of consumption. RESULTS The adjusted mean household purchase of vegetables was 42.9 g/per capita/day. The adjusted mean individual consumption was 46.1 g. There was an inverse relation between household purchase and individual consumption of vegetables and ultra-processed foods. Ten types of vegetables account for more than 80% of the total amount usually purchased. The variety consumed was, on average, 1.08 type/per capita/day. Approximately 60% of the vegetables were eaten raw, and the amount consumed at lunch was twice that consumed at dinner; individuals with higher consumption of ultra-processed foods tended to consume even less vegetables at dinner. CONCLUSIONS The consumption of vegetables in Brazil is insufficient, and this is worse among individuals with higher consumption of ultra-processed foods. The most frequent habit was to consume raw vegetables at lunch and with limited variety.

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RESUMO OBJETIVO Analisar a efetividade de intervenções educativas realizadas em serviços de saúde na melhoria de comportamentos e desfechos clínicos em saúde bucal. MÉTODOS Foi realizada uma revisão sistemática da literatura com busca nas bases de dados PubMed, Lilacs e SciELO. Foram incluídos estudos que investigaram intervenções realizadas por profissionais de saúde atuantes em serviços de saúde e que utilizaram como principal abordagem ações de educação com a finalidade de melhorar desfechos comportamentais e clínicos em saúde bucal. RESULTADOS A busca totalizou 832 artigos e 14 preencheram todos os critérios de inclusão. Cinco estudos verificaram exclusivamente a efetividade das intervenções na redução de cárie, três avaliaram excepcionalmente comportamentos em saúde bucal, os demais artigos julgaram a efetividade das intervenções tanto para desfechos clínicos (cárie dentária e condições periodontais) quanto para comportamentos em saúde bucal. A maioria dos estudos (n = 9) foi baseada em ensaios randomizados e controlados, os demais avaliaram o antes e depois da intervenção. Cinco estudos reportaram redução significativa de cárie dentária, e cinco dos seis estudos que avaliaram desfechos comportamentais encontraram alguma mudança positiva. CONCLUSÕES A maioria dos estudos que avaliaram desfechos comportamentais e periodontais mostrou melhorias significativas a favor das intervenções. Todos os estudos que avaliaram cárie mostraram a diminuição de novas lesões ou casos da doença nos grupos que receberam as intervenções, embora apenas cinco dos 11 artigos tenham encontrado uma diferença estatisticamente significativa. As intervenções educativas realizadas por profissionais de saúde no contexto de sua prática apresentam potencial em promover a saúde bucal da população.

Resumo em Inglês:

ABSTRACT OBJECTIVE To analyze the effectiveness of educational interventions performed in health services in the improvement of clinical behaviors and outcomes in oral health. METHODS We have carried out a systematic review of the literature searching the PubMed, Lilacs, and SciELO databases. We have included studies that have investigated interventions performed by health professionals working in health services and who have used educational actions as main approach to improve behavioral and clinical outcomes in oral health. RESULTS The search amounted to 832 articles and 14 of them met all the inclusion criteria. Five studies have only exclusively evaluated the effectiveness of interventions on caries reduction, three have exceptionally evaluated oral health behaviors, and the other articles have evaluated the effectiveness of interventions for both clinical outcomes (dental caries and periodontal conditions) and behaviors in oral health. Most of the studies (n = 9) were based on randomized controlled trials; the other ones have evaluated before and after the intervention. Five studies have reported a significant reduction of dental caries, and five of the six studies evaluating behavioral outcomes have found some positive change. CONCLUSIONS Most studies evaluating behavioral and periodontal outcomes have shown significant improvements in favor of interventions. All studies evaluating caries have shown a reduction in new lesions or cases of the disease in the groups receiving the interventions, although only five of the eleven articles have found a statistically significant difference. Educational interventions carried out by health professionals in the context of their practice have the potential to promote oral health in the population.

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RESUMO OBJETIVO: Desenvolver um Índice de Qualidade da Dieta Adaptado para Gestantes (IQDAG) e avaliar sua relação com características de mulheres atendidas pelo Sistema Único de Saúde. MÉTODOS: Os dados de consumo alimentar são provenientes de um estudo transversal conduzido entre 785 gestantes adultas do município de Ribeirão Preto, SP, entre 2011 e 2012. A elaboração do índice foi baseada nas recomendações do Ministério da Saúde, em índices dietéticos nacionais prévios e no novo Guia Alimentar para a População Brasileira. Para descrever a qualidade da dieta segundo as características maternas, foram empregados os testes ANOVA, Kruskal-Wallis e qui-quadrado. RESULTADOS: O IQDAG apresenta nove componentes, sendo representados por três grupos de alimentos (em porções/1.000 kcal); cinco nutrientes; e um componente moderador. Elevada proporção de gestantes atingiu a pontuação máxima para os componentes leguminosas e hortaliças. Porém, poucas mulheres atingiram a pontuação máxima para o consumo de frutas frescas, ingestão de fibras, ômega 3, cálcio, folato, ferro e alimentos ultraprocessados. Verificou-se melhor qualidade da dieta entre gestantes de maior idade, eutróficas, que relataram praticar mais tempo de atividade física e que faziam uso de suplementos dietéticos. A maior pontuação do índice também foi observada entre as mulheres com maior ingestão de carboidratos, proteínas, vitaminas C, E e A, e dos minerais cálcio, folato e ferro, bem como entre aquelas com menor ingestão de gorduras totais e gorduras saturadas. CONCLUSÕES: O presente índice dietético foi inédito ao incorporar a recomendação do novo Guia Alimentar para a População Brasileira quanto à moderação do consumo de alimentos ultraprocessados. Demonstrou-se útil na avaliação da qualidade da dieta de gestantes e uma maior pontuação foi verificada entre mulheres de maior idade, eutróficas e que relataram um estilo de vida saudável. Estratégias de promoção do consumo de frutas frescas, alimentos ricos em fibras, ômega 3, cálcio, folato, ferro e minimamente processados em gestantes são necessárias.

Resumo em Inglês:

ABSTRACT OBJECTIVE: To develop a Diet Quality Index Adapted for Pregnant Women (IQDAG) and to evaluate its relation with the characteristics of women treated at the Brazilian Unified Health System. METHODS: The data on food intake come from a cross-sectional study carried out with 785 adult pregnant women in the city of Ribeirão Preto, state of São Paulo, Brazil, between 2011 and 2012. The index was based on the recommendations of the Brazilian Ministry of Health, previous national dietary indexes, and the new Dietary Guidelines for the Brazilian Population. We used the ANOVA, Kruskal-Wallis, and chi-square tests to describe the quality of the diet according to the characteristics of the mother. RESULTS: The IQDAG has nine components, and it is represented by three food groups (in servings/1,000 kcal), five nutrients, and a moderator component. A high proportion of pregnant women reached the maximum score for the components of legumes and vegetables. However, few women reached the maximum score for consumption of fresh fruits, fiber, omega-3, calcium, folate, iron, and ultra-processed foods. We verified a better quality of diet among older and eutrophic pregnant women who reported practicing more physical activity and taking dietary supplements. We also observed the highest index score among women with higher intake of carbohydrates, proteins, vitamins C, E, and A, and minerals calcium, folate, and iron, as well as among those with lower intake of total fats and saturated fats. CONCLUSIONS: This dietary index is unprecedented in incorporating the recommendation of the new Dietary Guidelines for the Brazilian Population regarding the moderation of the consumption of ultra-processed foods. It was useful in evaluating the quality of the diet of pregnant women and we verified a higher score among older and eutrophic women who reported a healthy lifestyle. Strategies are needed to promote a higher consumption of fresh fruits, foods high in fiber, omega-3, calcium, folate, iron, and minimally processed foods in pregnant women.

Resumo em Inglês:

ABSTRACT OBJECTIVE: To evaluate if the closer follow-up with the supply of insulin pens and the measurement of capillary blood glucose improve the management of older patients with type 2 diabetes without adequate glycemic control despite extensive therapy. METHODS: This is a prospective, non-randomized, quasi-experimental study. We have included 45 patients over 60 years old, from both sexes, with glycated hemoglobin (HbA1c) > 8.5% using oral hypoglycemic agents and insulin. The intervention consisted of monthly medical visits, with the provision of insulin pens and strips for blood glucose measurement. All patients received insulin pen, refills of Neutral Protamine Hagedorn and regular insulin, needles for the pen, blood glucose meter, and capillary blood glucose tests (three tests/day). Treatment was adjusted with the same endocrinologist monthly for six months. Glycated hemoglobin was measured at baseline and 12 and 24 weeks after intervention. RESULTS: Glycated hemoglobin at baseline was 10.34% (SE = 0.22%) and 8.54% (SE = 0.24%, p < 0.001) and 8.09% (SE = 0.21%, p < 0.001) at 12 and 24 weeks after intervention, respectively, with a significant reduction from baseline. CONCLUSIONS: More frequent medical visits, with treatment inputs including the use of insulin pens and self-monitoring, have improved glycemic control (reduction of 2.25% in HbA1C, on average, at 24 weeks of follow-up). Our data support a change in the management and medical behavior of older patients with chronically decompensated diabetes.

Resumo em Inglês:

ABSTRACT OBJECTIVE: To investigate how stressful life events and social support relate to central adiposity in Southern Brazil. METHODS: Data included information from 802 participants in the 1982 Pelotas Birth Cohort that was collect in 2004-2005 and 2006. Stratifying by sex, we studied self-reported stressful life events during the year before 2004-2005 in relation to change in waist circumference between 2004-2005 and 2006 and waist-to-hip ratio in 2006, using both bivariate and multivariate linear regression models. RESULTS: In adjusted models, the experience of stressful life events during the year before 2004-2005 predicted a change in waist circumference in 2006 in men and a change in both waist-to-hip ratio in 2006 and waist circumference between 2004-2005 and 2006 in women. Men who experienced two or more stressful events had on average a one centimeter increase in their waist circumference between 2004-2005 and 2006 (β = 0.97, 95%CI 0.02-1.92), compared to those reporting no stressful events. For women, those who had one and those who had two or more stressful life events had over a 1 cm increase in their waist circumference from 2004-2005 to 2006 (β = 1.37, 95%CI 0.17-2.54; β = 1.26, 95%CI 0.11-2.40, respectively), compared to those who did not experience any stressful event. For both sexes, social support level was not significantly related to either waist-to-hip ratio or change in waist circumference, and it did not modify the association between stress and central adiposity. CONCLUSIONS: The experience of more than one stressful life event was associated with distinct indicators of central adiposity for men versus women.

Resumo em Português:

RESUMO OBJETIVO: Analisar a relação entre condições de promoção de saúde nas escolas e o consumo de álcool e outras drogas pelos escolares. MÉTODOS: Estudo transversal de base escolar, com amostra probabilística de 3.464 escolares de 12 a 17 anos de todas as escolas de Lajeado e Sapiranga, RS, e 53 gestores das mesmas escolas; dados coletados em 2012. Os relatos do uso de 2012 de tabaco, álcool e drogas ilícitas foram tomados como desfechos e o escore de promoção de saúde no ambiente das escolas, como exposição de interesse. Os dados foram submetidos à análise multinível. RESULTADOS: A prevalência do uso anual de tabaco foi 9,8% (IC95% 8,8-10,8), álcool 46,2% (IC95% 44,5-47,8) e outras drogas 10,9% (IC95% 9,9-12,0). Na análise bruta, apenas o uso de tabaco esteve associado a escolas menos promotoras (OR = 1,89; IC95% 1,16-3,09) quando comparado as com melhores condições. Essa associação perdeu significância estatística na análise ajustada (OR = 1,27; IC95% 0,74-2,19). CONCLUSÕES: Os efeitos do ambiente escolar quanto ao uso de drogas, especialmente tabaco e álcool, manifestam-se principalmente pelas condições individuais e familiares dos adolescentes.

Resumo em Inglês:

ABSTRACT OBJECTIVE: To analyze the relationship between the health promotion conditions in schools and the consumption of alcohol and other drugs by students. METHODS: This is a cross-sectional study with a probabilistic sample of 3,464 students aged 12 to 17 from all schools of the cities of Lajeado and Sapiranga, state of Rio Grande do Sul, Brazil, and 53 managers from the same schools; the data was collected in 2012. Reports of the use of tobacco, alcohol, and illicit drugs in 2012 were used as outcomes, and the health promotion score in the school environment was used as the exposure of interest. We submitted the data to multilevel analysis. RESULTS: The prevalence of the annual use of tobacco was 9.8% (95%CI 8.8-10.8), alcohol was 46.2% (95%CI 44.5-47.8), and other drugs was 10.9% (95%CI 9.9-12.0). In the crude analysis, only the use of tobacco was associated with less health promoting schools (OR = 1.89, 95%CI 1.16-3.09) when compared to those with better conditions. This association lost statistical significance in the adjusted analysis (OR = 1.27, 95%CI 0.74-2.19). CONCLUSIONS: The effects of the school environment on the use of drugs, especially tobacco and alcohol, are manifested mainly by the individual and family conditions of the adolescents.

Resumo em Português:

RESUMO OBJETIVO Descrever a utilização de unidades básicas de saúde conforme a cobertura por cartão de desconto e plano de saúde. MÉTODOS Inquérito domiciliar na área de abrangência da Estratégia Saúde da Família de Pelotas, RS, entre dezembro de 2007 e fevereiro de 2008, incluindo pessoas de todas as faixas etárias. A frequência de busca por atendimento (médico ou não) nas unidades básicas de saúde nos últimos seis meses e a prevalência do uso das unidades básicas de saúde para a última consulta médica (caso esta tivesse sido realizada até seis meses atrás, e tivesse tido um motivo que não rotina) foram analisadas por regressão de Poisson ajustada para o delineamento amostral. RESULTADOS Das 1.423 pessoas, 75,6% não estavam cobertas por cartão de desconto ou plano de saúde. A frequência média da busca por atendimento (médico ou não) foi de 1,6 vezes em seis meses (IC95% 1,3-2,0); essa frequência foi 55,8% menor (p < 0,001) entre as pessoas cobertas por plano de saúde em comparação às pessoas sem cartão de desconto ou plano de saúde. Dentre as últimas consultas médicas, 35,8% (IC95% 25,4-47,7) tinham sido realizadas nas unidades básicas de saúde; essa prevalência foi 36,4% menor (p = 0,003) entre as pessoas cobertas por cartão de desconto e 87,7% menor (p = 0,007) entre as pessoas cobertas por plano de saúde em comparação às pessoas com ambas as coberturas. CONCLUSÕES A cobertura por plano de saúde e, em menor grau, a cobertura por cartão de desconto associam-se a uma menor utilização das unidades básicas de saúde. Isso pode ser utilizado para dimensionar a população sob a responsabilidade de cada equipe de Estratégia Saúde da Família, na medida em que os agentes comunitários de saúde sejam capazes de diferenciar cartão de desconto e plano de saúde durante o cadastramento das famílias.

Resumo em Inglês:

ABSTRACT OBJECTIVE To describe the utilization of basic health units according to coverage by discount card or private health insurance. METHODS Household survey in the area covered by Family Health Strategy in Pelotas, state of Rio Grande do Sul, Brazil, from December 2007 to February 2008, with persons of all age groups. The frequency of (medical or non-medical) healthcare seeking at the basic health units in the last six months and the prevalence of basic health unit utilization for the last medical consultation (in case it had been performed up to six months before, for a non-routine reason) were analyzed by Poisson regression adjusted for the sampling design. RESULTS Of the 1,423 persons, 75.6% had no discount card or private health insurance. The average frequency of (medical or non-medical) healthcare seeking was 1.6 times in six months (95%CI 1.3-2.0); this frequency was 55.8% lower (p < 0.001) among privately insured persons compared to those with no discount card or private health insurance. Among the last medical consultations, 35.8% (95%CI 25.4-47.7) had been performed at the basic health units; this prevalence was 36.4% lower (p = 0.003) among persons covered by discount card and 87.7% lower (p = 0.007) among privately insured persons compared to those without both coverages. CONCLUSIONS Private health insurance and, to a lesser degree, discount card coverage, are related to lower utilization of basic health units. This can be used to size the population under the accountability of each Family Health Strategy team, to the extent that community health workers are able to differentiate discount card from PHI during family registration.

Resumo em Inglês:

ABSTRACT OBJECTIVE: To verify whether an intervention based on disseminating health evidence summaries by e-mail to health professionals increases access to health evidence databases, and whether health professionals intend to apply the evidence received by e-mail in their clinical practice. METHODS: This quantitative study started with a survey to collect demographic data and patterns of access to health evidence databases. It was followed by a longitudinal intervention, over 48 weeks, that disseminated 143 health evidence summaries to 339 health professionals with higher education degree who work in the Brazilian Unified Health System. In the longitudinal intervention phase, health professionals voluntarily assessed the received health evidence summaries using the information assessment method. Finally, the study concluded with a survey to identify changes in accessing health evidence databases. RESULTS: Of the 339 Brazilian health professionals participating in this research, 90 (26.5%) answered the initial and final surveys. After 48 weeks, there was an increase in the use of health evidence databases; 186 (54.9%) participants submitted 7,942 assessments of health evidence summaries, which were relevant for patient care in 5,409 (68%) assessments. CONCLUSIONS: The dissemination of health evidence summaries by e-mail to health professionals in Brazil increases the reported use of evidence in clinical practice.

Resumo em Inglês:

ABSTRACT OBJECTIVE To estimate age and sex-specific suicide rates, compare suicide rates between indigenous communities, and quantify the frequency of intrafamilial suicide clustering. METHODS We performed a retrospective cohort study involving 14,666 indigenous individuals in reservations in Dourados, state of Mato Grosso do Sul, Brazil, from 2003 through 2013 using national and local census. RESULTS The overall suicide rate was 73.4 per 100,000 person-years. Adolescent males aged 15-19 and girls aged 10-14 had the highest rates for each sex at 289.3 (95%CI 187.5-391.2) and 85.3 (95%CI 34.9-135.7), respectively. Comparing the largest reservations, Bororo had a higher suicide rate than Jaguapiru (RR = 4.83, 95%CI 2.85-8.16) and had significantly lower socioeconomic indicators including income and access to electricity. Nine of 19 suicides among children under 15 occurred in household clusters. Compared with adult suicides, a greater proportion of child (OR = 5.12, 95%CI 1.89-13.86, p = 0.001) and adolescent (OR = 3.48, 95%CI 1.29-9.44, p = 0.017) suicides occurred within household clusters. CONCLUSIONS High rates of suicide occur among children and adolescents in these indigenous reservations, particularly in poor communities. Nearly half of child suicides occur within household clusters. These findings underscore the need for broad public health interventions and focused mental health interventions in households following a suicide.

Resumo em Inglês:

ABSTRACT OBJECTIVE To identify and analyze factors associated with preventable child deaths. METHODS This analytical cross-sectional study had preventable child mortality as dependent variable. From a population of 34,284 live births, we have selected a systematic sample of 4,402 children who did not die compared to 272 children who died from preventable causes during the period studied. The independent variables were analyzed in four hierarchical blocks: sociodemographic factors, the characteristics of the mother, prenatal and delivery care, and health conditions of the patient and neonatal care. We performed a descriptive statistical analysis and estimated multiple hierarchical logistic regression models. RESULTS Approximatelly 35.3% of the deaths could have been prevented with the early diagnosis and treatment of diseases during pregnancy and 26.8% of them could have been prevented with better care conditions for pregnant women. CONCLUSIONS The following characteristics of the mother are determinant for the higher mortality of children before the first year of life: living in neighborhoods with an average family income lower than four minimum wages, being aged ≤ 19 years, having one or more alive children, having a child with low APGAR level at the fifth minute of life, and having a child with low birth weight.

Resumo em Inglês:

ABSTRACT OBJECTIVE To analyze the effects of maternal pre-pregnancy body mass index and weight gain during pregnancy on the baby's birth weight. METHODS We conducted a cross-sectional study with 5,024 mothers and their newborns using a Brazilian birth cohort study. In the proposed model, estimated by structural equation modeling, we tested socioeconomic status, age, marital status, pre-pregnancy body mass index, smoking habit and alcohol consumption during pregnancy, hypertension and gestational diabetes, gestational weight gain, and type of delivery as determinants of the baby's birth weight. RESULTS For a gain of 4 kg/m2 (1 Standard Deviation [SD]) in pre-pregnancy body mass index, there was a 0.126 SD increase in birth weight, corresponding to 68 grams (p < 0.001). A 6 kg increase (1 SD) in gestational weight gain represented a 0.280 SD increase in newborn weight, correponding to 151.2 grams (p < 0.001). The positive effect of pre-pregnancy body mass index on birth weight was direct (standardized coefficient [SC] = 0.202; p < 0.001), but the negative indirect effect was small (SC = -0.076, p < 0.001) and partially mediated by the lower weight gain during pregnancy (SC = -0.070, p < 0.001). The positive effect of weight gain during pregnany on birth weight was predominantly direct (SC = 0.269, p < 0.001), with a small indirect effect of cesarean delivery (SC = 0.011; p < 0.001). Women with a higher pre-pregnancy body mass index gained less weight during pregnancy (p < 0.001). CONCLUSIONS The effect of gestational weight gain on the increase in birth weight was greater than that of pre-pregnancy body mass index.

Resumo em Português:

RESUMO OBJETIVO Verificar se existe associação entre qualidade da dieta e inserção das mulheres no mercado de trabalho e se o nível de escolaridade modificaria essa associação; analisar as diferenças segundo escolaridade; e avaliar se a inserção ou não no mercado modifica a associação entre qualidade da dieta e escolaridade. MÉTODOS Trata-se de estudo transversal de base populacional, que utilizou dados do Inquérito de Saúde de Campinas (ISACamp 2008). A alimentação de 464 mulheres, de 18 a 64 anos, foi avaliada por meio do Índice de Qualidade da Dieta Revisado. Foram estimadas as médias do escore total e dos componentes do índice com o uso de regressão linear simples e múltipla. RESULTADOS Nenhuma diferença foi observada entre qualidade da dieta de donas de casa e trabalhadoras remuneradas. A análise estratificada por escolaridade mostrou menor ingestão de frutas entre as donas de casa no segmento de pior escolaridade, em comparação às trabalhadoras remuneradas. Entre as mulheres, a menor escolaridade esteve associada à pior qualidade global da dieta e à maior ingestão de sódio e menor ingestão de frutas, vegetais, grãos integrais, leite e gordura saturada. Em contraste, a inserção no mercado de trabalho modificou o efeito da escolaridade sobre a qualidade da dieta. No estrato de donas de casa, a baixa escolaridade foi associada à pior qualidade da dieta e ao menor consumo de frutas, vegetais verde-escuros e alaranjados e grãos integrais. Entre as trabalhadoras remuneradas, a baixa escolaridade mostrou-se associada à ingestão maior de sódio e menor de vegetais, cereais integrais e leite e laticínios. CONCLUSÕES Os resultados expõem iniquidades no perfil alimentar em relação à escolaridade e à inserção no mercado de trabalho, sinalizando a relevância de políticas públicas que ampliem o acesso à educação e à orientação sobre dieta saudável.

Resumo em Inglês:

ABSTRACT OBJECTIVE To verify whether there is an association between the quality of the diet and the inclusion of women in the labor market and whether the education level would modify this association. We have analyzed the differences according to education level and evaluated whether the insertion or not in the market modifies the association between the quality of the diet and education level. METHODS This is a cross-sectional population-based study that has used data from the Campinas Health Survey (2008 ISACamp). We have evaluated the diet of 464 women, aged 18 to 64 years, using the Brazilian Healthy Eating Index – Revised. We have estimated the means of the total score and index components using simple and multiple linear regression. RESULTS We have observed no difference in the quality of diet of working and stay-at-home women. The analysis stratified by education level showed a lower intake of fruits among stay-at-home women in the segment of lower education level, in relation to working women. Among all women, a lower education level was associated with lower overall quality of the diet, higher intake of sodium, and lower intake of fruits, vegetables, whole grains, milk, and saturated fat. On the other hand, the inclusion in the labor market changed the effect of the education level on the quality of the diet. In the stay-at-home stratum, a low education level was associated with poorer quality of the diet and lower consumption of fruits, dark green and orange vegetables, and whole grains. Among the working women, a low education level was associated with higher intake of sodium and lower intake of vegetables, whole grains, and milk and dairy products. CONCLUSIONS The results show inequities in the profile of food in relation to education level and inclusion in the labor market, which shows the relevance of public policies that increase the access to education and provide guidance on a healthy diet.

Resumo em Português:

RESUMO OBJETIVO Descrever e comparar variações dos fatores associados à prevalência de diarreia em menores de cinco anos no estado de Pernambuco. MÉTODOS Foram utilizados os bancos de dados de dois inquéritos de base populacional nos anos de 1997 e 2006, com 2.078 e 1.650 crianças, respectivamente, avaliadas em 18 municípios de Pernambuco (Região Metropolitana do Recife, interior urbano e rural). As variáveis, alocadas em níveis hierárquicos, foram analisadas por meio de razões de prevalência e regressão de Poisson. RESULTADOS Apenas quatro variáveis se mostraram independentemente associadas e constaram no modelo final hierarquizado: área geográfica, número de pessoas por cômodo, idade materna e idade da criança. Em 1997: interior urbano = 1,33 (IC95% 1,06–1,66), interior rural = 1,22 (IC95% 0,97–1,53) e em 2006: interior urbano = 1,87 (IC95% 1,31–2,66), interior rural = 2.07 (IC95% 1.50–2.85); número de pessoas por cômodo (1997): 1 a menos de 2 = 1,29 (IC95% 0,98-1,68), dois ou mais = 1,47 (IC95% 1,11–1,95) e em 2006: 1 a menos de 2 = 0.86 (IC95% 0,68–1,09), dois ou mais = 1,29 (IC95% 0,94–1,75); idade materna (1997): 10 a 19 anos = 1,48 (IC95% 1,05–2,08), 20 a 24 anos = 1,23 (IC95% 0,94–1,60), 25 a 34 anos = 1,01 (IC95% 0,78–1,30) e em 2006: 10 a 19 anos = 1,70 (IC95% 1,08–2,66), 20 a 24 anos = 1,64 (IC95% 1,16–2,32), 25 a 34 anos = 1,20 (IC95% 0,89–1,62); e idade da criança (1997): 0–11 meses = 1,57 (IC95% 1,27–1,94), 12–23 meses = 1,73 (IC95% 1,41–2,12) e em 2006: 0–11 meses = 1,04 (IC95% 0,76–1,41), 12–23 meses = 1,77 (IC95% 1,41–2,23). CONCLUSÕES Houve uma grande variabilidade dos condicionantes das diarreias em crianças entre os dois períodos analisados. Em nível de políticas públicas, apesar de mudanças em termos de pessoas, sequências temporais e espaços geográficos, as diarreias continuam em uma escala importante no elenco de prioridades do poder governamental.

Resumo em Inglês:

ABSTRACT OBJECTIVE Describe and compare variations of the factors associated with the prevalence of diarrhea in children under five years old in the state of Pernambuco. METHODS We used the databases of two population-based surveys from the years 1997 and 2006, with 2,078 and 1,650 children, respectively, evaluated in 18 municipalities of Pernambuco (Metropolitan Region of Recife, urban and rural interior). The variables, allocated at hierarchical levels, were analyzed using prevalence and Poisson regression ratios. RESULTS Only four variables were independently associated and were included in the final hierarchical model: geographical area, number of people per room, maternal age and the age of the child. In 1997: urban interior = 1.33 (95%CI 1.06–1.66), rural interior = 1.22 (95%CI 0.97–1.53) and in 2006: urban interior = 1.87 (95%CI 1.31–2.66), rural interior = 2.07 (95%CI 1.50–2.85); number of persons per room (1997): 1 to less than 2 = 1.29 (95%CI 0.98–1.68), two or more = 1.47 (95%CI 1.11–1.95) and in 2006: 1 to less than 2 = 0.86 (95%CI 0.68–1.09), two or more = 1.29 (95%CI 0.94–1.75); maternal age (1997): 10 to 19 years = 1.48 (95%CI 1.05–2.08), 20 to 24 years = 1.23 (95%CI 0.94–1.60), 25 to 34 years = 1.01 (95%CI 0.78–1.30) and in 2006: 10 to 19 years old = 1.70 (95%CI 1.08–2.66), 20 to 24 years old = 1.64 (95%CI 1.16–2.32), 25 to 34 years = 1.20 (95%CI 0.89–1.62); and age of the child (1997): 0–11 months = 1.57 (95%CI 1.27–1.94), 12–23 months = 1.73 (95%CI 1.41–2.12) and in 2006: 0–11 months = 1.04 (95%CI 0.76–1.41), 12–23 months = 1.77 (95%CI 1.41–2.23). CONCLUSIONS There was a great variability of the conditioners of diarrhea in children between the two periods analyzed. At the public policy level, despite changes in terms of people, time sequences, and geographic spaces, diarrhea remains on an important scale in the ranking of government power.

Resumo em Português:

RESUMO OBJETIVO Investigar a associação entre a exposição aos espaços verdes e a mortalidade por doenças isquêmicas do coração e cerebrovasculares, e o papel do nível socioeconômico nessa relação, no município do Rio de Janeiro, Brasil. MÉTODOS Estudo ecológico, tendo os setores censitários como unidade de análise. Foram utilizados os dados de óbitos por doenças isquêmicas do coração e cerebrovasculares, entre residentes com idade acima de 30 anos, ocorridos de 2010 a 2012. A exposição ao verde foi estimada por meio do Índice de Vegetação por Diferença Normalizada, baseado em imagens de satélite. As associações entre a exposição aos espaços verdes e a taxas de mortalidade por doenças isquêmicas do coração e cerebrovasculares, padronizadas por sexo e idade, foram analisadas por meio de modelos condicionais autorregressivos, ajustados pelas densidades de vias de tráfego leve e pesado, proxy de poluição, e pela situação socioeconômica, mensurada pelo Índice de Desenvolvimento Social. Também foram realizadas análises estratificadas por níveis socioeconômicos, dados pelos tercis do Índice de Desenvolvimento Social. RESULTADOS Entre os setores mais verdes, com Índice de Vegetação por Diferença Normalizada acima do terceiro quartil, a redução da mortalidade por doenças isquêmicas do coração foi de 6,7% (IC95% 3,5–9,8) e por cerebrovascular foi de 4,7% (IC95% 1,2–8,0). Na análise estratificada, o efeito protetor dos espaços verdes na mortalidade por doenças isquêmicas do coração foi observado entre os setores mais verdes de todos os estratos, sendo maior para os de menor nível socioeconômico (8,6%; IC95% 1,8–15,0). No caso da mortalidade por doenças cerebrovasculares, o efeito protetor foi verificado apenas para os setores mais verdes do nível socioeconômico mais baixo (9,6%; IC95% 2,3–16,5). CONCLUSÕES As taxas de mortalidade por doenças isquêmicas do coração e cerebrovasculares são inversamente associadas à exposição aos espaços verdes, controlando o nível socioeconômico e a poluição do ar. O efeito protetor dos espaços verdes é maior entre os setores de nível socioeconômico mais baixo.

Resumo em Inglês:

ABSTRACT OBJECTIVE Investigate the association between exposure to green spaces and mortality from ischemic heart and cerebrovascular diseases, and the role of socioeconomic status in this relationship, in the city of Rio de Janeiro, Brazil. METHODS Ecological study, with the census tracts as unit of analysis. This study used data from deaths due to ischemic heart and cerebrovascular diseases among residents aged over 30 years, from 2010 to 2012. Exposure to green was estimated using the Normalized Difference Vegetation Index based on satellite images. The associations between exposure to green spaces and mortality rates due to ischemic heart and cerebrovascular diseases, standardized by gender and age, were analyzed using conditional autoregressive models, adjusted for the density of light and heavy traffic routes, pollution proxy, and by the socioeconomic situation, measured by the Social Development Index. Analyzes stratified by socioeconomic levels were also carried out, given by the tertiles of the Social Development Index. RESULTS Among the greener sectors, with a Normalized Difference Vegetation Index above the third quartile, the reduction in mortality due to ischemic heart disease was 6.7% (95%CI 3.5–9.8) and cerebrovascular was 4.7% (95%CI 1.2–8.0). In the stratified analysis, the protective effect of green spaces on ischemic heart disease mortality was observed among the greenest sectors of all strata, and it was higher for those with a lower socioeconomic level (8.6%, 95%CI 1.8–15.0). In the case of mortality due to cerebrovascular diseases, the protective effect was verified only for the greenest sectors of the lowest socioeconomic level (9.6%, 95%CI 2.3–16.5). CONCLUSIONS Mortality rates for ischemic heart and cerebrovascular diseases are inversely associated with exposure to green spaces when controlling socioeconomic status and air pollution. The protective effect of green spaces is greater among the tracts of lower socioeconomic level.

Resumo em Espanhol:

RESUMEN OBJETIVO Estimar la prevalencia de Burnout en un hospital de media-larga estancia, monitorizar su evolución y evidenciar la importancia de los puntos de corte utilizados para evitar sesgos en la interpretación de los resultados. MÉTODOS Se realizaron dos estudios transversales (2013–2016), aplicando la versión española del cuestionario Maslach Burnout Inventory al personal de un hospital de crónicos (n = 323). Fueron variables resultado: prevalencia de Burnout y alto grado de afectación de las subescalas y variables predictoras: características sociodemográficas y factores desencadenantes y moduladores del síndrome. La asociación entre variables se cuantificó mediante odds ratio. RESULTADOS El índice de participación pasó del 31,5% al 39,3%. Los profesionales presentaron un nivel medio de Burnout en ambos momentos, observándose menor grado de afectación de las subescalas de despersonalización y realización personal en el corte realizado en 2016. La puntuación media de las subescalas en 2016 fue 21,5 para el cansancio emocional, 4,7 para la despersonalización y 41,7 para la realización personal, frente a los valores de cansancio emocional = 21,6, despersonalización = 6,9 y realización personal = 36,3 obtenidos en 2013. La puntuación de la escala de cansancio emocional fue ligeramente superior al valor promedio de los estudios nacionales (19,9), mientras que el resto de valores fueron similares a los valores promedio de los estudios considerados. La prevalencia de Burnout y la interpretación de los resultados variaron significativamente en función de los puntos de corte considerados. En ambos estudios, las variables sociodemográficas mostraron escasa significación, mientras que el apoyo social y las relaciones interpersonales se asociaron al grado de Burnout de los profesionales. CONCLUSIONES Nuestra prevalencia de Burnout fue similar a la de otros estudios consultados, aunque el componente emocional es más marcado en nuestro medio. La interpretación de los resultados varió significativamente en función de los puntos de corte aplicados, debido a las diferencias transculturales.

Resumo em Inglês:

ABSTRACT OBJECTIVE To estimate the prevalence of Burnout in a medium or long-stay hospital, to monitor its evolution and to highlight the importance of cut-off points used to avoid distortions in the interpretation of the results. METHODS Two cross-sectional studies (2013–2016) were carried out, applying the Spanish version of the Maslach Burnout Inventory to the staff of a chronic care hospital (n = 323). Result variables were: Burnout prevalence and a high degree of affectation of the subscales and predictor variables: sociodemographic characteristics and factors that trigger and modulate the syndrome. The association between variables was quantified using odds ratio. RESULTS The participation rate went from 31.5% to 39.3%. The professionals presented a mean level of Burnout in both moments, observing a lower degree of affectation of the depersonalization subscales and personal accomplishment in the 2016 cut-off. The average score of the subscales in 2016 was 21.5 for emotional fatigue, 4.7 for depersonalization and 41.7 for personal fulfillment, compared to the values of emotional fatigue = 21.6, depersonalization = 6.9 and personal fulfillment = 36.3 obtained in 2013. The emotional fatigue score was slightly higher than the mean value of the national studies (19.9), while the rest of the values were similar to the mean values of the studies considered. The prevalence of Burnout and the interpretation of the results varied significantly according to the cut-off points considered. In both studies, sociodemographic variables showed little significance, while social support and interpersonal relationships were associated with the degree of burnout among professionals. CONCLUSIONS Our prevalence of Burnout was similar to that of other studies consulted, although the emotional component is more marked in our environment. The interpretation of the results varied significantly according to the cut-off points applied, due to the cross-cultural differences.

Resumo em Português:

RESUMO OBJETIVO: Verificar a adequação e os fatores associados ao cumprimento do esquema vacinal (BCG, DTP-Hib, SCR, VCP-10) em crianças internadas com pneumonia em um hospital de referência pediátrica no Nordeste do Brasil. MÉTODOS: Estudo transversal, descritivo com componente analítico, composto por 452 crianças hospitalizadas por pneumonia no Instituto de Medicina Integral Prof. Fernando Figueira, entre 2010 e 2013. Critérios de inclusão: idade de um mês a menores de cinco anos; com comprovação do cartão vacinal. Critérios de exclusão: pneumonia hospitalar ou doença de base concomitante. Avaliamos a adequação do esquema vacinal da BCG, tetravalente, tríplice viral e pneumocócica conjugada 10 valente (VPC-10). Foram utilizados os testes qui-quadrado e exato de Fisher seguidos de regressão multivariada de Poisson, estimando-se as razões de prevalência brutas, ajustadas e os respectivos intervalos de confiança de 95%. Participaram da análise multivariada as variáveis que na análise univariada apresentaram valor p < 0,20. RESULTADOS: Houve boa adequação no calendário vacinal, exceto a vacina VPC-10, que apresentou percentual inferior a 85%. Observou-se associação entre o adequado cumprimento do esquema vacinal e escolaridade materna (89,9% ensino médio completo), sexo da criança (87,2% feminino), idade da criança (94,2% menor que seis meses) e aleitamento materno (84,3% amamentaram). CONCLUSÕES: Pela elevada taxa na escolaridade materna e pelo elevado percentual de alimentação por leite materno, pode-se entender que há uma melhor compreensão no cuidado da saúde da criança pelas genitoras estudadas nesta pesquisa, apresentando a eficácia das políticas públicas de alimentação infantil. Porém, as crianças não tiveram uma boa adequação do esquema vacinal da VPC-10, uma das principais vacinas contra a pneumonia, podendo ser esse um dos principais fatores nas causas do internamento, não apresentando influência com a classificação da gravidade da doença. Enfatiza-se dessa maneira que as causas de morbidade por pneumonia não são associadas a um único fator.

Resumo em Inglês:

ABSTRACT OBJECTIVE: To verify the adequacy and factors associated with compliance with the immunization schedule (BCG, DTP-Hib, MMR, PCV-10) in children hospitalized with pneumonia at a pediatric referral hospital in Northeast Brazil. METHODS: This is a cross-sectional, descriptive study with an analytical component, with a sample of 452 children hospitalized with pneumonia at the Instituto de Medicina Integral Prof. Fernando Figueira, between 2010 and 2013. The inclusion criterion was children aged from one month to less than five years of age with proof in the immunization record. The exclusion criterion was the presence of hospital-acquired pneumonia or concomitant disease. We have evaluated the adequacy of the immunization schedule for the BCG, tetravalent, MMR, and 10-valent pneumococcal conjugate (PCV-10) vaccines. We used the chi-square test and Fisher's exact test followed by multivariate Poisson regression, estimating the crude and adjusted prevalence ratios and respective 95% confidence intervals. The variables with p < 0.20 in the univariate analysis were included in the multivariate analysis. RESULTS: There was good adequacy in the immunization schedule, except for PCV-10, which presented a percentage lower than 85%. We have observed an association between adequate compliance with the immunization schedule and education level of the mother (89.9% complete high school), sex of the child (87.2% female), age of the child (94.2% younger than six months), and breastfeeding (84.3% breastfed). CONCLUSIONS: Given the high rate of education level of the mother and the high percentage of breastfeeding, we can understand that there is a better understanding of the health of the child by the mothers studied in this study, showing the effectiveness of public policies for infant feeding. However, children did not have good adequacy of the immunization schedule of PCV-10, one of the main vaccines against pneumonia, which can be one of the main factors in the causes of hospitalization, with no influence on the classification of the severity of the disease. In this way, we emphasize that the causes of pneumonia morbidity are not associated with a single factor.

Resumo em Português:

RESUMO OBJETIVO: Analisar os riscos relacionados às vacinas e os impactos da não vacinação para a população mundial. MÉTODOS: Revisão narrativa que considerou informações contidas nas bases de dados bibliográficos NCBI-PubMed, Medline, Lilacs e Scientific Electronic Library Online (SciELO), no período compreendido entre novembro de 2015 e novembro de 2016. Para a análise de surtos ocasionados pela não vacinação foram considerados os trabalhos publicados entre 2010 e 2016. RESULTADOS: Foram descritos os principais componentes das vacinas oferecidas pelo sistema público de saúde brasileiro e eventos adversos associados a esses elementos. Com exceção de reações inflamatórias locais e efeitos raros como exacerbação de doenças autoimunes e alergias, não foi demonstrada relação causal entre a administração de vacinas e autismo, mal de Alzheimer ou narcolepsia. Por outro lado, a falta de informações e a divulgação de informações não científicas têm contribuído para a reemergência de doenças infecciosas em diversos países no mundo e põe em risco planos globais para a erradicação de doenças infecciosas. CONCLUSÕES: A população deve estar bem informada quanto aos benefícios da vacinação e os profissionais da saúde devem assumir o papel de divulgar informações verídicas e com respaldo científico sobre o tema, como compromisso ético e profissional junto à sociedade.

Resumo em Inglês:

ABSTRACT OBJECTIVE: To analyze the risks related to vaccines and the impacts of non-vaccination on the world population. METHODS: This is a narrative review that has considered information present in the bibliographic databases NCBI-PubMed, Medline, Lilacs, and Scientific Electronic Library Online (SciELO), between November 2015 and November 2016. For the analysis of outbreaks caused by non-vaccination, we considered the work published between 2010 and 2016. RESULTS: We have described the main components of the vaccines offered by the Brazilian public health system and the adverse events associated with these elements. Except for local inflammatory reactions and rare events, such as exacerbation of autoimmune diseases and allergies, no causal relationship has been demonstrated between the administration of vaccines and autism, Alzheimer's disease, or narcolepsy. On the other hand, the lack of information and the dissemination of non-scientific information have contributed to the reemergence of infectious diseases in several countries in the world and they jeopardize global plans for the eradication of these diseases. CONCLUSIONS: The population should be well informed about the benefits of vaccination and health professionals should assume the role of disseminating truthful information with scientific support on the subject, as an ethical and professional commitment to society.

Resumo em Português:

RESUMO OBJETIVO: Analisar se variáveis clínicas, sociodemográficas e de acesso aos serviços odontológicos influenciam o impacto da saúde bucal nas atividades diárias de adolescentes, adultos e idosos. MÉTODOS: Estudo transversal com dados secundários da Pesquisa Estadual de Saúde Bucal (SB São Paulo 2015) realizada em 163 municípios de São Paulo. Participaram do inquérito 17.560 indivíduos de três grupos etários: adolescentes de 15–19 anos (n = 5.558), adultos de 35–44 anos (n = 6.051) e idosos de 65 anos ou mais (n = 5.951). A seleção foi feita por amostra probabilística por conglomerados em dois estágios. A variável desfecho foi o impacto da saúde bucal sobre as atividades diárias, avaliado pelo questionário Oral Impacts on Daily Performances, contendo questões sobre comer, falar, higiene bucal, relaxamento, prática esportiva, sorriso, estudo ou trabalho, contato social e sono. O Oral Impacts on Daily Performances foi dicotomizado em com e sem impacto. As variáveis independentes foram as sociodemográficas, clínicas e de acesso, divididas em três blocos. Realizou-se análise de regressão logística múltipla hierarquizada considerando o plano amostral complexo de conglomerados. Cada observação recebeu um peso específico, dependendo da localização que resultou em frequências ponderadas e ajustadas para o efeito do delineamento. RESULTADOS: A presença de impacto da saúde bucal foi constatada em 27,9% dos indivíduos. No bloco 1, o sexo feminino e o grupo étnico preto/pardo tiveram maior chance de impacto da saúde bucal na qualidade de vida, bem como os adultos e idosos em relação aos adolescentes. No bloco 2, a renda familiar até R$1.500 teve associação com a presença de impacto. No bloco 3, os indivíduos que relataram dor de dente, frequentaram o serviço público e procuraram tratamento odontológico tiveram maior chance de impacto. CONCLUSÕES: As variáveis sociodemográficas, clínica e de acesso ao serviço de saúde influenciam o impacto da saúde bucal nas atividades diárias de adolescentes, adultos e idosos.

Resumo em Inglês:

ABSTRACT OBJECTIVE: Analyze if clinical, sociodemographic and access to dental services variables influence the impact of oral health on the daily activities of adolescents, adults and older adults. METHODS: A cross-sectional study with secondary data from the State Oral Health Survey (SB São Paulo 2015) conducted in 163 cities of São Paulo. A total of 17,560 individuals from three age groups: 15–19-year-old (n = 5,558), 35–44-year-old (n = 6,051), and older people of 65 years or more (n = 5,951) participated in the survey. The selection was made by probabilistic sample by conglomerates in two stages. The endpoint variable was the impact of oral health on daily activities, evaluated by the Oral Impacts on Daily Performances questionnaire, containing questions about eating, talking, oral hygiene, relaxation, sports practice, smile, study or work, social contact, and sleep. Oral Impacts on Daily Performances was dichotomized with and without impact. The independent variables were sociodemographic, clinical and access variables, divided into three blocks. A hierarchical multiple logistic regression analysis was performed considering the complex sampling plan of clusters. Each observation received a specific weight, depending on the location that resulted in weighted frequencies and adjusted for the design effect. RESULTS: The presence of oral health impact was observed in 27.9% of the individuals. In block 1, female gender and black/brown ethnic group had a greater chance of impact of oral health on quality of life, as well as the adults and the older adults in relation to adolescents. In block 2, family income up to R$1,500 was associated with the presence of impact. In block 3, individuals who reported toothache, used the public service and sought dental treatment had a greater chance of impact. CONCLUSIONS: Sociodemographic, clinical and access to health services variables influence the impact of oral health on the daily activities of adolescents, adults and older adults.

Resumo em Português:

RESUMO OBJETIVO: Estimar a cobertura de notificação de casos de infecção pelo HIV em gestantes, o aumento na cobertura de notificação a ser obtido pela busca rotineira de dados em outros sistemas de informação nacionais, e identificar oportunidades perdidas de identificação de gestantes HIV+ em maternidades brasileiras. MÉTODOS: Estudo descritivo, de relacionamento de base de dados de estudo nacional com coleta primária de dados (estudo “Nascer no Brasil”), e de base de dados secundários de sistemas de informação nacionais. O estudo “Nascer no Brasil” é um estudo de base nacional, realizado em 2011–2012, com 23.894 puérperas, que identificou gestantes infectadas pelo HIV, utilizando registros em cartão de pré-natal e prontuário. Casos de gestantes com infecção pelo HIV identificadas no estudo “Nascer no Brasil” foram pesquisadas no Sistema de Informação de Agravos de Notificação, Sistema de Controle de Exames Laboratoriais da Rede Nacional de Contagem de Linfócitos CD4+/CD8+ e Carga Viral, e Sistema de Controle Logístico de Medicamentos. Utilizou-se o software OpenRecLink para relacionamento das bases de dados. Foi estimada a cobertura de notificação, com respectivo intervalo de confiança, dos sistemas de informação nacionais avaliados. RESULTADOS: A cobertura de notificação de HIV em gestantes no Sistema de Informação de Agravos de Notificação foi estimada em 57,1% (IC95% 42,9–70,2), e 89,3% das gestantes HIV+ (IC95% 81,2–94,2) foram localizadas em algum dos sistemas de informação nacionais pesquisados. A busca em outros sistemas de informação nacionais resultaria em aumento de 57,1% dos casos notificados. Não foram identificadas oportunidades perdidas de diagnóstico de gestantes HIV+ nas maternidades avaliadas pelo estudo “Nascer no Brasil”. CONCLUSÕES: A busca rotineira de informação em outros sistemas de informação nacionais, procedimento utilizado pelo Ministério da Saúde para casos de Aids em adultos e em crianças, deve ser adotado para os casos de infecção pelo HIV na gestação.

Resumo em Inglês:

ABSTRACT OBJECTIVE: To estimate the coverage of the reporting of cases of HIV-infected pregnant women, to estimate the increase in the coverage of the reporting with the routine search of data in other Brazilian health information systems, and to identify missed opportunities for identification of HIV-infected pregnant women in Brazilian maternity hospitals. METHODS: This is a descriptive study on the linkage of Brazilian databases with primary data from the “Nascer no Brasil” study and secondary database collection from national health information systems. The “Nascer no Brasil” is a national-based study carried out in 2011–2012 with 23,894 pregnant women, which identified HIV-infected pregnant women using prenatal and medical records. We searched for cases of HIV-infected pregnant women identified in the “Nascer no Brasil” study in the Information System of Notifiable Diseases, the Control System for Laboratory Tests of the National CD4+/CD8+ Lymphocyte Count and HIV Viral Load Network, and the Logistics Control System for Medications. We used the OpenRecLink software for the linkage of databases. We estimated the notification coverage, with the respective confidence interval, of the evaluated Brazilian health information systems. RESULTS: We estimated the coverage of the reporting of HIV-infected pregnant women in the Information System of Notifiable Diseases as 57.1% (95%CI 42.9–70.2), and we located 89.3% of the HIV-infected pregnant women (95%CI 81.2–94.2) in some of the Brazilian health information systems researched. The search in other national health information systems would result in an increase of 57.1% of the reported cases. We identified no missed opportunities for the diagnosis of HIV+ in pregnant women in the maternity hospitals evaluated by the “Nascer no Brasil” study. CONCLUSIONS: The routine search for information in other Brazilian health information systems, a procedure carried out by the Ministry of Health for cases of AIDS in adults and children, should be adopted for cases of HIV in pregnancy.

Resumo em Português:

RESUMO OBJETIVO: Descrever o comportamento sexual e identificar fatores associados em adolescentes de comunidades rurais da Bahia. MÉTODOS: Estudo transversal, de base populacional e abordagem domiciliar, realizado em 2015, com adolescentes entre 10 e 19 anos. Foram descritos: relação sexual alguma vez na vida e nos últimos 12 meses; idade na primeira relação sexual; uso de preservativo e número de parceiros; orientação sobre gravidez, aids ou outras infecções sexualmente transmissíveis e como conseguir preservativo. Foi realizada análise para a amostra total e para os estratos quilombola e não quilombola. Utilizou-se regressão de Poisson, com variância robusta, para estimar as razões de prevalências para a relação sexual em relação às variáveis explicativas. RESULTADOS: Foram entrevistados 390 adolescentes, sendo 42,8% quilombolas, 51,3% do sexo feminino e mediana de idade de 14,8 anos. Desses, 26,4% relataram ocorrência de relação sexual (28,1% quilombolas e 25,1% não quilombolas), com mediana de idade da primeira relação com 15,0 anos; 77,7% mencionaram o uso de preservativo na última relação e mais da metade recebeu orientações sobre gravidez, aids ou outras infecções sexualmente transmissíveis e não recebeu orientações sobre como conseguir preservativo gratuito. Mostraram-se positivamente associados à ocorrência de relação sexual, após ajuste: idade (RP = 1,42) e ter experimentado uma dose de álcool (RP = 2,41). No estrato quilombola, a idade (RP = 1,37), ter três e mais amigos próximos (RP = 1,37) e experimentação de álcool (RP = 2,60) mostraram-se associados. No não quilombola, mostraram-se associados idade (RP = 1,43), raça/cor negra (RP = 2,06) e experimentação de álcool (RP = 2,68). CONCLUSÕES: A carência de informações e a exposição a comportamentos como o uso de álcool são condições que necessitam ser contempladas nas estratégias de promoção de saúde e prevenção de agravos à saúde sexual de adolescentes de zona rural. Ainda há necessidade de potencializar parcerias intersetoriais entre educação e saúde para fomentar o exercício autônomo e seguro da sexualidade nessa população.

Resumo em Inglês:

ABSTRACT OBJECTIVE: To describe the sexual behavior and to identify associated factors in adolescents from rural communities in Bahia, Brazil. METHODS: This is a cross-sectional, population-based, and household-based study, carried out in 2015 with adolescents aged 10 to 19 years. We described the variables of sexual intercourse in life and in the last 12 months, age at first intercourse, condom use and number of partners, guidance on pregnancy, AIDS, or other sexually transmitted infections, and guidance on how to get condoms. The analysis was performed for the total sample and for the quilombola and nonquilombola strata. We used Poisson regression, with robust variance, to estimate the prevalence ratios for sexual intercourse in relation to the explanatory variables. RESULTS: A total of 390 adolescents were interviewed, of them 42.8% were quilombolas, 51.3% females, and the median age was 14.8 years. Of these adolescents, 26.4% reported sexual intercourse (28.1% quilombolas and 25.1% non-quilombolas), and the median age of the first relation was 15 years; 77.7% of them mentioned condom use in the last intercourse and more than half received guidance on pregnancy, AIDS, or other sexually transmitted infections and received no guidance on how to get free condoms. Age (PR = 1.42) and alcohol use experimentation (PR = 2.41) were positively associated with sexual intercourse after adjustment. In the quilombola stratum, age (RP = 1.37), having three or more close friends (PR = 1.37), and experimentation with alcohol (PR = 2.60) were associated. In the non-quilombola stratum, age (PR = 1.43), black persons (PR = 2.06), and alcohol use experimentation (PR = 2.68) were associated. CONCLUSIONS: Lack of information and exposure to behaviors such as alcohol use experimentation are conditions that need to be addressed in health promotion strategies and in strategies for the prevention of sexual health problems in rural adolescents. Intersectoral partnerships between education and health also need to be strengthened to promote the autonomous and safe exercise of sexuality in this population.

Resumo em Português:

RESUMO OBJETIVO: Analisar a avaliabilidade dos Núcleos de Apoio à Saúde da Família com foco na integração às equipes apoiadas. MÉTODOS: Estudo de avaliabilidade em que foram realizadas análise documental e modelização da intervenção com foco no trabalho integrado às equipes apoiadas, o que permitiu descrever dimensões, objetivos e resultados esperados. Foram definidos indicadores de resultados e suas respectivas medidas e fontes de informação. Foram aplicadas técnicas de consenso com informantes-chave para validação dos modelos e da matriz de indicadores. RESULTADOS: O estudo de avaliabilidade mostrou-se apropriado, possibilitando melhor definição e conhecimento acerca da intervenção. CONCLUSÕES: Há coerência entre os objetivos dos Núcleos de Apoio à Saúde da Família e sua estruturação, ainda que existam dificuldades para operacionalizá-los. É recomendado proceder a uma avaliação formativa dos Núcleos de Apoio à Saúde da Família com foco no trabalho integrado às equipes apoiadas buscando fortalecê-los para o alcance dos resultados esperados.

Resumo em Inglês:

ABSTRACT OBJECTIVE: To evaluate the Brazilian Family Health Support Centers focusing on the integration to supported teams. METHODS: This is an evaluation study in which we carried out a documentary analysis and modeling of the intervention focusing on the work integrated to the supported teams, which has allowed us to describe dimensions, objectives, and expected results. We defined the outcome indicators and their respective measures and sources of information. We used consensus techniques with key informants to validate the models and the matrix of indicators. RESULTS: The evaluation study was appropriate, and it allowed a better definition and knowledge about the intervention. CONCLUSIONS: There is coherence between the objectives of the Family Health Support Centers and their structure, although there are difficulties to operationalize them. We recommend a formative evaluation of the Family Health Support Centers focusing on the work integrated to the supported teams, seeking to strengthen them to achieve the expected results.

Resumo em Português:

RESUMO OBJETIVO: Analisar a forma como médicos, enquanto parte de um grupo sociocultural, lidam com diferentes tipos de morte, em um serviço de pronto socorro metropolitano. MÉTODOS: Trata-se de uma etnografia realizada em um dos maiores serviços de pronto socorro da América Latina. A coleta dos dados deu-se ao longo de nove meses de observação participante e entrevistas com 43 médicos de diferentes especialidades – 25 homens e 18 mulheres, entre 28 e 69 anos. RESULTADOS: À análise, guiada pelo modelo dos Signos, Significados e Ações, nota-se um vasto mosaico de situações e questões que medeiam o cuidado médico em uma unidade de pronto socorro. Os resultados apontaram que os médicos podem considerar uma morte mais difícil se comparada a outras, a depender de critérios: o etário; a identificação ou não com o paciente; as circunstâncias da morte e o questionamento médico quanto a sua responsabilidade no processo de morte. CONCLUSÕES: Para os médicos, nenhuma morte é fácil. Cada morte pode ser mais ou menos difícil, a depender de diferentes critérios que medeiam o cuidado médico em uma unidade de pronto socorro e revelam questões de ordem social, ética e moral das mais diversas.

Resumo em Inglês:

ABSTRACT OBJECTIVE: To analyze how physicians, as part of a sociocultural group, handle the different types of death, in a metropolitan emergency service. METHODS: This is an ethnography carried out in one of the largest emergency services in Latin America. We have collected the data for nine months with participant observation and interviews with 43 physicians of different specialties – 25 men and 18 women, aged between 28 and 69 years. RESULTS: The analysis, guided by the model of Signs, Meanings, and Actions, shows a vast mosaic of situations and issues that permeate the medical care in an emergency unit. The results indicate that physicians may consider one death more difficult than another, depending on the criteria: age, identification or not with the patient, circumstances of the death, and medical questioning as to their responsibility in the death process. CONCLUSIONS: For physicians, no death is easy. Each death can be more or less difficult, depending on different criteria that permeate the medical care in an emergency unit, and it reveals different social, ethical, and moral issues.

Resumo em Inglês:

ABSTRACT OBJECTIVE The objective of this study is to investigate the adherence and the factors that influence adherence to physical activity in adults with dyslipidemia, hypertension, or diabetes. METHODS The analyses were based on data collected at the baseline of the 14,521 participants from the study ELSA-Brasil aged between 35 and 74 years. The level of leisure time physical activity was determined using the International Physical Activity Questionnaire. Logistic regression analyses were performed to examine the influence of the demographic data, socioeconomic conditions, perceived health status, and access to exercise facilities in the neighborhood on adherence to physical activity. RESULTS Men with hypertension and dyslipidemia were more active than women. The results show that 17.8%, 15.1%, and 13.9% of the subjects who reported dyslipidemia, hypertension, and diabetes, respectively, adhere to the physical activity recommendations. The factors positively associated with adherence were higher education and income. Older individuals who reported poor perceived health, were overweight and obese, regularly smoked, and had fewer opportunities to exercise in the neighborhood presented lower adherence. CONCLUSIONS The number of adults with dyslipidemia, hypertension, and diabetes who adhere to the physical activity recommendations is very low. Higher education and income are positively associated with adherence, while age, excess body weight, negative perceived health, regular smoking, and lack of opportunity to exercise in the neighborhood were considered barriers to physical activity.

Resumo em Espanhol:

RESUMEN OBJETIVO Comparar la morbilidad hospitalaria por cáncer entre población local e inmigrante en Chile. MÉTODOS Estudio de prevalencia basado en el análisis de egresos hospitalarios de todos los centros de Chile. Se caracterizaron los egresos hospitalarios por cáncer en 2012 según condición migratoria. Se estimaran las tasas brutas y específicas de morbilidad hospitalaria por esta causa, para finalmente analizar su asociación con el estatus migratorio mediante una regresión binomial negativa inflada por ceros ajustada por variables sociodemográficas. RESULTADOS Las neoplasias fueron la tercera causa de egresos hospitalarios en inmigrantes y la séptima en chilenos. La tasa ajustada de egresos hospitalarios por cáncer fue mayor en chilenos que en inmigrantes, y estos presentaron menor cantidad de días de hospitalización y mayor proporción de intervenciones quirúrgicas. En el grupo de inmigrantes, los egresos hospitalarios por cáncer corresponderán principalmente a pacientes pertenecientes al sistema privado (46%) y en chilenos a pacientes en el sistema público (71,1%). Se observó una amplia diferencia en la proporción de egresos hospitalarios por cáncer correspondientes a pacientes sin previsión de salud entre ambas poblaciones (22,6%: inmigrantes, 1,0%: chilenos). En ambas poblaciones, los tres cánceres que se presentaron con mayor frecuencia fueron: (i) tejidos linfáticos, órganos hematopoyéticos y tejidos afines, (ii) órganos digestivos y (iii) cáncer de mama. CONCLUSIONES Se deben considerar modelos de atención diferenciada en inmigrantes, creando programas específicos de información, cobertura y protección frente al cáncer. Es necesario generar más información sobre esta problemática a nivel local e internacional.

Resumo em Inglês:

ABSTRACT OBJECTIVE To compare cancer hospital morbidity among the local population and the immigrant population in Chile. METHODS This is a prevalence study based on the analysis of hospital discharges of all the health centers of Chile. Cancer hospital discharges were characterized in 2012 according to the migratory status. The crude and specific rates of hospital morbidity for this cause were estimated for the analysis of their association with migratory status using zero-inflated negative binomial regression, adjusted for sociodemographic variables. RESULTS The neoplasms were the third cause of hospital discharges for immigrants and the seventh one for Chileans. The adjusted rate of cancer hospital discharges was higher for Chileans than immigrants, and the latter had fewer days of hospitalization and greater proportion of surgical interventions. In the group of immigrants, cancer hospital discharges mainly corresponded to patients belonging to the private system (46%), and in the group of Chileans they mainly corresponded to patients in the public system (71.1%). We observed a large difference in the proportion of cancer hospital discharges for patients with no health insurance between the two populations (22.6%: immigrants, 1.0%: Chileans). In both populations, the three most frequent types of cancer were: (i) lymphoid tissue, hematopoietic organs, and related tissues, (ii) digestive organs, and (iii) breast cancer. CONCLUSIONS Models of differentiated care should be considered for immigrants, with the creation of specific programs of information, coverage, and protection against cancer. More information on this problem must be generated at the local and international level.

Resumo em Inglês:

ABSTRACT OBJECTIVE To determine the trans fatty acids content of processed foods frequently consumed by adults living in a Rio de Janeiro, Brazil, after the enactment of a mandatory trans fatty acids labelling policy. METHODS Between February 2014 and January 2015, a specifically dietary questionnaire was completed by 107 adults to assess the frequency of processed foods consumption. The most commonly consumed products from the survey, including vegetable oils, margarine, biscuits, snacks, cheese bread (pão de queijo), french fries, cheeseburger and ice cream, were then analyzed for their trans fatty acids content using gas chromatography with a flame ionization detector. RESULTS Differences in the levels of trans fatty acids were observed among 22 products analyzed, considering that trans fatty acids content ranged between 0.0 g/100 g in samples of cream cracker biscuit 1 and olive oil to 0.83 g/100 g in samples of cheeseburger (fast food), 0.51 g/100 g in samples of frozen pão de queijo and 12.92 g/100 g in samples of chocolate sandwich cookies with cream filling 2. The overall trans fatty acids content of the different samples of margarine brands was 0.20 g/100 g for brand 1 and 0.0 g/100 g for brand 2. These data are significantly lower than those observed in a survey conducted in 2003, when the regulation had been enacted. CONCLUSIONS Our data indicate that Brazilian regulation is very likely implicated in the observed drop in trans fatty acids of the most processed foods but has yet to eliminate them, which reinforces the urgent need to revise the legislation, since a minimum amount of trans fat does not mean that the food product does not contain this type of fat.

Resumo em Português:

RESUMO OBJETIVO : Descrever o uso de internet e identificar os fatores sociodemográficos e de saúde associados a mudanças no uso de internet ao longo de quatro anos em idosos participantes do estudo EpiFloripa Idoso. MÉTODOS : Estudo longitudinal de base populacional e domiciliar com 1.197 idosos residentes na área urbana de Florianópolis, SC. Aplicou-se entrevista face a face. A descrição do uso de internet foi realizada segundo a frequêcia, o local, os aparelhos e os motivos de uso da internet. Para identificar os fatores associados a mudanças no uso de internet, o desfecho foi categorizado em: manteve o não uso de internet; passou a não usar internet; passou a usar internet; e manteve o uso de internet. As variáveis independentes foram sexo, idade, renda familiar, escolaridade, arranjo familiar, status conjugal, presença de cuidador, trabalho remunerado e rastreamento de déficit cognitivo. Utilizou-se regressão multinomial logística com estimativas de razão risco relativo (RRR) e seus respectivos intervalos de confiança (IC95%). RESULTADOS : A prevalência de uso de internet aumentou de 22,9% em 2009–2010 para 26,6% em 2013–2014. Do total de idosos participantes do estudo, 7,5% passaram a usar internet, 3,2% deixaram de usar, 19,1% mantiveram o uso e 70,2% mantiveram o não uso no período analisado. Dos idosos que usavam internet, a maioria usava todos os dias ou quase todos os dias da semana, em sua própria casa, em computadores de mesa ou portáteis, com o principal objetivo de enviar e receber mensagens, buscar informações para aprender ou investigar alguma coisa, encontrar informações sobre bens e serviços e usar sites de notícias, de redes sociais e de informações sobre saúde. Os fatores associados à manutenção, ao longo de quatro anos, do uso da internet foram: ser do sexo masculino (RRR = 2,19; IC95% 1,48–3,26), ter maior renda salarial mensal familiar (RRR = 3,53; IC95% 1,35–9,23), ter maior escolaridade (RRR = 2,64; IC95% 1,57–4,43) e não ter cuidador (RRR = 0,08; IC95% 0,02–0,31). CONCLUSÕES : Apesar de o uso da internet estar aumentando entre os idosos, a maior parte dessa população ainda é digitalmente excluída, especialmente as mulheres de menor renda e escolaridade. Estratégias que promovam a inclusão digital de idosos devem ser estimuladas visando à universalização do uso de internet e devem levar em consideração as desigualdades socioeconômicas e de gênero.

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ABSTRACT OBJECTIVE To describe the use of the internet and to identify the sociodemographic and health factors associated with changes in the use of the internet over four years in older adults participating in the Brazilian EpiFloripa Idoso study. METHODS This is a longitudinal home-based, population-based study with 1,197 older adults who live in the urban area of Florianópolis, State of Santa Catarina, Brazil. We applied a face-to-face interview. We describe the use of internet according to frequency, place, devices, and motives of the use of the internet. To identify factors associated with changes in the use of the internet, we categorized the outcome as: non-use of the internet, stopped using the internet, started using the internet, and kept using the internet. The independent variables were sex, age, family income, education level, family arrangement, marital status, presence of caregiver, paid work, and cognitive impairment screening. We used multinomial logistic regression with risk ratio (RR) estimates and their respective confidence intervals (95%CI). RESULTS The prevalence of the use of internet increased from 22.9% in 2009–2010 to 26.6% in 2013–2014. Of the total number of older adults who participated in the study, 7.5% started using the internet, 3.2% stopped using it, 19.1% kept their use, and 70.2% kept their non-use in the analyzed period. Of the older adults who used the internet, most used it every day or almost every day of the week, in their own home, on desktop or portable computers, mainly to send and receive messages, to search for information to learn or investigate something, to find information about goods and services, and to use news, social networking, and health information websites. The factors associated with the use of internet over four years were: being male (RR = 2.19, 95%CI 1.48–3.26), higher monthly family income (RR = 3.53, 95%CI 1.35–9.23), higher education level (RR = 2.64, 95%CI 1.57–4.43), and no presence of caregiver (RR = 0.08, 95%CI 0.02–0.31). CONCLUSIONS Although the use of the internet is increasing among older adults, most of the population is still digitally excluded, especially women with lower income and education level. Strategies that promote the digital inclusion of older adults should be stimulated, aiming to universalize the use of the internet, and they should take into account socioeconomic and gender inequalities.

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ABSTRACT OBJECTIVE To analyze how individual characteristics and the social context, together, are associated with self-perception of the oral health. METHODS A multilevel cross-sectional study with data from the Brazilian National Health Survey 2013, the United Nations Development Program, and the National Registry of Health Establishments. The explanatory variables for the “oral health perception” outcome were grouped, according to the study framework, into biological characteristics (sex, color, age), proximal social determinants (literacy, household crowding, and socioeconomic stratification), and distal (years of schooling expectancy at age 18, GINI, Human Development Index, and per capita income). The described analysis was performed, along with bivariate Poisson analysis and multilevel Poisson analysis for the construction of the explanatory model of oral health perception. All analyzes considered the sample weights. RESULTS Both the biological characteristics and the proximal and distal social determinants were associated with the perception of oral health in the bivariate analysis. A higher prevalence of bad oral health was associated to lower years of schooling expectancy (PR = 1.31), lower per capita income (PR = 1.45), higher income concentration (PR = 1.41), and worse human development (PR = 1.45). Inversely, oral health services in both primary and secondary care were negatively associated with oral health perception. All the biological and individual social characteristics, except reading and writing, made up the final explanatory model along with the distal social determinants of the Human Development Index and coverage of basic care in the multilevel analysis. CONCLUSIONS Biological factors, individual and contextual social determinants were associate synergistically with the population’s perception of oral health. It is necessary to improve individual living conditions and the implementation of public social policies to improve the oral health of the population.

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ABSTRACT OBJECTIVE To evaluate if the provision of clinical dental care, by means of the main curative procedures recommended in Primary Health Care, is associated with team structural characteristics, considering the presence of a minimum set of equipment, instrument, and supplies in Brazil’s primary health care services. METHODS A cross-sectional exploratory study based on data collected from 18,114 primary healthcare services with dental health teams in Brazil, in 2014. The outcome was created from the confirmation of five clinical procedures performed by the dentist, accounting for the presence of minimum equipment, instrument, and supplies to carry them out. Covariables were related to structural characteristics. Poisson regression with robust variance was used to obtain crude and adjusted prevalence ratios, with 95% confidence intervals. RESULTS A total of 1,190 (6.5%) dental health teams did not present the minimum equipment to provide clinical dental care and only 2,498 (14.8%) had all the instrument and supplies needed and provided the five curative procedures assessed. There was a positive association between the outcome and the composition of dental health teams, higher workload, performing analysis of health condition, and monitoring of oral health indicators. Additionally, the dental health teams that planned and programmed oral health actions with the primary care team monthly provided the procedures more frequently. Dentists with better employment status, career plans, graduation in public health or those who underwent permanent education activities provided the procedures more frequently. CONCLUSIONS A relevant number of Primary Health Care services did not have the infrastructure to provide clinical dental care. However, better results were found in dental health teams with oral health technicians, with higher workload and that plan their activities, as well as in those that employed dentists with better working relationships, who had dentists with degrees in public health and who underwent permanent education activities.

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ABSTRACT OBJECTIVE To investigate the impact of dental pain on daily performances among five-year-old Brazilian children. METHODS The study used data of 7,280 five-year-old children participating in the 2010 Brazilian Oral Health Survey (SBBrasil 2010 Project). Children were clinically examined and their parents or carers were interviewed at their homes. The outcome was the prevalence of the oral impacts on daily performance, and the explanatory variable was dental pain in the last six months. Other independent variables were children’s gender and skin color/race, family income, household overcrowding, and caries experience (dmft). Rao-Scott test and Poisson regression for complex samples were carried out. RESULTS The prevalence of impacts on daily performances was 26.1% (95%CI 22.3–30.2). Significant associations were found between the outcome and pain, caries experience, and sociodemographic variables. After adjusting for the independent variables, only pain and caries remained significant. Impacts on daily performances were more frequent among children with pain (PR = 1.14, 95%CI 1.06–1.23) compared to those without pain. Children with low dmft (PR = 1.90, 95%CI 1.39–2.60) and those with high dmft (PR = 3.53, 95%CI 2.78–4.49) had a higher prevalence of impact than those with no caries experience. CONCLUSIONS Dental pain and caries had strong negative impacts on the five-year-old children’s daily performances regardless of their demographic and socioeconomic characteristics.

Resumo em Português:

RESUMO OBJETIVO Estimar o custo do diagnóstico e tratamento da asma. MÉTODOS Foi utilizada a perspectiva da sociedade. Foram incluídos por 12 meses em 2011–2012, sequencialmente, 117 indivíduos maiores de cinco anos de idade, em tratamento por asma nos Serviços de Pneumologia e Alergia-Imunologia da Policlínica Piquet Carneiro, Universidade do Estado do Rio de Janeiro. Todos realizaram duas entrevistas com seis meses de intervalo para coleta de dados, cobrindo 12 meses. As unidades de custos foram identificadas e valoradas de acordo com métodos definidos. Foi feita análise de sensibilidade e foram aplicados métodos estatísticos com nível de significância de 5% para comparações de custos entre subgrupos. RESULTADOS Cento e oito pacientes completaram o estudo, 73,8% eram mulheres. Mediana de idade foi de 49,5 anos. Rinite esteve presente em 83,3%, e mais da metade tinha sobrepeso ou obesidade. A renda familiar média foi de R$1.566,19/mês (DP = 1.503,30). A maioria dos trabalhadores e dos estudantes teve absenteísmo relacionado à asma. O custo médio anual total foi de R$2.207,99/paciente (DP = 2.220,55). O custo relacionado à asma isolada foi de R$1.984,17/paciente-ano (DP = 2.232,55). Asmáticos obesos, graves ou não controlados tiveram maiores custos em comparação aos não obesos (p = 0,001), não graves e controlados (p = 0,000). O custo direto correspondeu a 82,3% do custo total estimado. O custo com medicamentos para asma correspondeu a 62,2% dos custos diretos da asma. CONCLUSÕES Medicamentos para asma, medidas de controle ambiental e licenças de saúde prolongadas tiveram maior impacto potencial na variação do custo total. Os resultados são uma estimativa do custo do tratamento da asma em nível secundário no Sistema Único de Saúde, assumindo-se que o tratamento utilizado represente a abordagem ideal da doença.

Resumo em Inglês:

ABSTRACT OBJECTIVE To estimate the cost of diagnosis and treatment of asthma. METHODS We used the perspective of society. We sequentially included for 12 months, in 2011-2012, 117 individuals over five years of age who were treated for asthma in the Pneumology and Allergy-Immunology Services of the Piquet Carneiro Polyclinic, Universidade do Estado do Rio de Janeiro. All of them were interviewed twice with a six-month interval for data collection, covering 12 months. The cost units were identified and valued according to defined methods. We carried out a sensitivity analysis and applied statistical methods with a significance level of 5% for cost comparisons between subgroups. RESULTS The study consisted of 108 patients, and 73.8% of them were women. Median age was 49.5 years. Rhinitis was present in 83.3% of the individuals, and more than half were overweight or obese. Mean family income was U$915.90/month (SD = 879.12). Most workers and students had absenteeism related to asthma. Total annual mean cost was U$1,291.20/patient (SD = 1,298.57). The cost related to isolated asthma was U$1,155.43/patient-year (SD = 1,305.58). Obese, severe, and uncontrolled asthmatic patients had higher costs than non-obese, non-severe, and controlled asthmatics, respectively. Severity and control level were independently associated with higher cost (p = 0.001 and 0.000, respectively). The direct cost accounted for 82.3% of the estimated total cost. The cost of medications for asthma accounted for 62.2% of the direct costs of asthma. CONCLUSIONS Asthma medications, environmental control measures, and long-term health leaves had the greatest potential impact on total cost variation. The results are an estimate of the cost of treating asthma at a secondary level in the Brazilian Unified Health System, assuming that the treatment used represents the ideal approach to the disease.

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RESUMO OBJETIVO Analisar a tendência da mortalidade infantil em Rio Branco, AC, de 1999 a 2015. MÉTODOS Estudo observacional ecológico de série temporal, em que foram utilizados dados de óbitos do Sistema de Informações sobre Mortalidade e Nascimentos do Sistema de Informações sobre Nascidos Vivos. Estimou-se a variação percentual anual por meio do software Joinpoint. RESULTADOS A taxa de mortalidade infantil reduziu de 26,99, em 1999, para 14,50, em 2015, por 1.000 nascidos vivos, com variação percentual anual de -4,37 (IC95% -5,4– -3,4). Quando estratificada por componentes etários, o neonatal apresentou variação percentual anual de -4,73 (IC95% -5,7– -3,7), e o pós-neonatal de -3,7 (IC95% -5,4– -2,0). A evitabilidade, as causas evitáveis e as causas mal definidas apresentaram tendência descendente em todo o período e as causas não claramente evitáveis apresentaram tendência ascendente até 2008. O grupo de causas que mais contribuiu para os óbitos infantis no período estudado foi o das afecções perinatais, seguido pelo das malformações, das doenças infecciosas e parasitárias, e do grupo das doenças respiratórias. CONCLUSÕES Apesar da tendência decrescente da taxa de mortalidade infantil na capital, quando comparada à de países desenvolvidos, mostra-se relativamente elevada.

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ABSTRACT OBJECTIVE Analyze the trend of infant mortality in Rio Branco, state of Acre, from 1999 to 2015. METHODS An ecological observational study of a time series, in which data from deaths from the Information System on Mortality and Births of the Information System on Live Births were used. The annual percentage change was estimated using the Joinpoint software. RESULTS The infant mortality rate decreased from 26.99 in 1999 to 14.50 in 2015 per 1,000 live births, with an annual percentage change of -4.37 (95%CI -5.4– -3.4). When stratified by age components, the neonatal period presented an annual percentage change of -4.73 (95%CI -5.7– -3.7), and the post-neonatal period was -3.7 (95%CI -5.4– -2.0). Avoidability, avoidable causes and poorly defined causes showed a downward trend throughout the period and causes not clearly preventable showed an upward trend until 2008. The group of causes that contributed most to the infant deaths during the period studied was perinatal diseases, followed by malformations, infectious and parasitic diseases, and respiratory diseases. CONCLUSIONS Despite the decreasing trend in infant mortality rates in the capital compared to developed countries, it is relatively high.

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RESUMO OBJETIVO Analisar a associação entre a exposição à água fluoretada e cárie dentária, em contexto de uso generalizado de creme dental fluoretado no Brasil, em cenário de baixa prevalência da doença. MÉTODOS Realizado estudo observacional transversal, de tipo censitário, na modalidade de duplo inquérito epidemiológico populacional, em dois municípios paulistas em 2014. Participaram adolescentes de 11 e 12 anos, imersos na sua condição de exposição (n = 184) ou não exposição (n = 128) à água fluoretada, há pelo menos cinco anos. As populações avaliadas residiam em comunidades da mesma região geográfica, de pequeno porte demográfico e com classificação socioeconômica similar, diferenciando-se apenas pela condição de exposição à água fluoretada (Silveiras) e de não exposição (São José do Barreiro). A experiência, a magnitude e o grau de polarização da cárie dentária nessas populações foram analisadas por meio dos índices CPOD e SiC e a associação foi testada empregando-se as estatísticas qui-quadrado de Pearson e razão de prevalência entre não expostos e expostos à água fluoretada. RESULTADOS Embora a experiência de cárie (CPOD ≥ 1) não tenha se associado com a exposição à água fluoretada (qui-quadrado = 1,78; p = 0,18; α = 5%), observou-se expressiva diferença na magnitude com que a doença atingiu a população: as médias CPOD foram de 1,76 em expostos e 2,60 em não expostos e as médias SiC foram de 4,04 e 6,16, respectivamente. O grau da polarização, indicado pela porcentagem de indivíduos com CPOD = 0, foi diferente, maior (41,8%) em expostos e menor (34,3%) em não expostos. A razão de prevalência entre não expostos e expostos foi de 1,13, indicando pouca expressividade na diferença das prevalências. CONCLUSÕES A exposição à água fluoretada implicou menores valores médios dos índices CPOD e SiC, ainda que em presença de exposição concomitante a dentifrício fluoretado, em cenário de baixa prevalência da doença e padrão similar de distribuição de cárie nas populações analisadas.

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ABSTRACT OBJECTIVE To analyze the association between exposure to fluoridated water and dental caries in a context of widespread use of fluoride toothpaste in Brazil, in a scenario of low prevalence of the disease. METHODS This is a cross-sectional observational study, of the census type, in the form of a double population-based epidemiological survey carried out in two municipalities of the state of São Paulo in 2014. The sample consisted of adolescents aged 11 and 12 years, exposed (n = 184) or not exposed (n = 128) to fluoridated water for at least five years. The populations studied lived in communities of the same geographic region and had small demographic size and similar socioeconomic classification, differing only in the exposure (Silveiras) or not exposure (São José do Barreiro) to fluoridated water. The experience, magnitude, and degree of polarization of dental caries in these populations were analyzed using the DMFT and SiC indexes, and the association was tested using Pearson’s chi-square statistics and prevalence ratio between those not exposed and those exposed to fluoridated water. RESULTS Although caries experience (DMFT ≥ 1) was not associated with exposure to fluoridated water (chi-square = 1.78; p = 0.18; α = 5%), a significant difference was observed in the magnitude with which the disease reached the population: the means of DMFT were 1.76 in those exposed and 2.60 in those not exposed and the means of SiC were 4.04 and 6.16, respectively. The degree of polarization, indicated by the percentage of subjects with DMFT = 0, was different, being it higher (41.8%) in subjects exposed and lower (34.3%) in subjects not exposed. The prevalence ratio between those not exposed and those exposed was 1.13, indicating little expressiveness in prevalence difference. CONCLUSIONS Exposure to fluoridated water implied lower mean values for the DMFT and SiC indexes, even in the presence of the concomitant exposure to fluoridated toothpaste, in a scenario of low prevalence of the disease, and with a similar pattern of caries distribution in the populations analyzed.

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RESUMO OBJETIVO Analisar a associação entre raça/cor da pele e a ocorrência da prematuridade. MÉTODOS Meta-análise com estudos observacionais, selecionados por revisão sistemática em bases de dados bibliográficos Medline e Biblioteca Virtual da Saúde com os descritores: “Race or ethnic group” e “ethnicity and health” associados às palavras “infant premature” e “obstetric labor premature”. Foram incluídos os artigos publicados no período de 2010 a 2014, do tipo epidemiológico observacional, nas línguas portuguesa, inglesa e espanhola. Foram excluídos os artigos que não possuíam resumos ou que fossem artigos de revisão, teses, dissertações e editorias. Foi adotado o risco relativo e seus respectivos intervalos de confiança (IC95%) como medidas de efeito, obtidos por meio do modelo de efeito aleatório e representados a partir do gráfico do tipo forest plot. Para analisar os possíveis vieses de publicação e qualidade dos estudos, foi utilizado o teste de Egger e a escala de Newcastle-Ottawa, respectivamente. RESULTADOS Dos 926 artigos identificados, 17 foram elegíveis para o estudo. Dos 17 textos completos publicados, sete eram estudos de coorte retrospectiva, nove eram transversais e um era caso-controle. Com exceção de um estudo, os demais relataram associação positiva entre a raça/cor da pele e a prematuridade. Comparado com recém-nascidos a termo, o risco relativo do efeito combinado naqueles que nasceram prematuros foi de 1,51 (IC95% 1,39–1,69). O gráfico de funil sugeriu viés de publicação. CONCLUSÕES A presente meta-análise indicou uma associação positiva para o risco da prematuridade segundo a raça/cor da pele.

Resumo em Inglês:

ABSTRACT OBJECTIVE To analyze the association between race/skin color and the occurrence of prematurity. METHODS Meta-analysis with observational studies, selected by a systematic review in the bibliographic databases Medline and Biblioteca Virtual da Saúde with the descriptors: “Race or ethnic group” and “ethnicity and health” associated with the words “infant premature” and “obstetric labor premature”. Articles published in the period from 2010 to 2014, of the observational epidemiological type, in Portuguese, English and Spanish, were included. Articles that did not have abstracts or that were review articles, theses, dissertations, and editorials were excluded. We adopted the relative risk and their respective confidence intervals (95%CI) as measures of effect, obtained through the random effect model and represented by the forest plot type graph. The Egger test and the Newcastle-Ottawa scale, respectively, were used to analyze possible publication biases and the quality of the studies. RESULTS Of the 926 articles identified, 17 were eligible for the study. Of the 17 full texts published, seven were retrospective cohort studies, nine were cross-sectional studies, and one was a case-control study. Except for one study, the others reported a positive association between race/color of skin and prematurity. Compared with full-term newborns, the relative risk of the combined effect in those born preterm was 1.51 (95%CI 1.39-1.69). The funnel chart suggested publication bias. CONCLUSIONS The present meta-analysis indicated a positive association for the risk of prematurity according to race/skin color.

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ABSTRACT OBJECTIVE To analyze the costs of hysterectomies performed in Brazil due to benign conditions, and to assess its hospital admittance and mortality rates. METHODS A retrospective cohort was carried out from January 2010 to December 2014, analyzing all hysterectomies (n = 428,346) registered on the DATASUS database between January 2010 and December 2014. Data were collected through a structured questionnaire and analyzed using the SPSS 20.0 for Windows. RESULTS Hospital admissions were 300,231 for total abdominal hysterectomies, 46,056 for vaginal hysterectomies, 29,959 for subtotal abdominal hysterectomies and 1,522 for laparoscopic hysterectomies. Mortality rates were 0.26%, 0.09%, 0.07% and 0.05% for subtotal, total abdominal, laparoscopic, and vaginal hysterectomies, respectively. Among the procedures studied, total abdominal hysterectomies had the most costs (R$217,802,574.77), followed by vaginal hysterectomies (R$24,173,490.00), subtotal abdominal hysterectomies (R$19.253.300,00) and laparoscopic hysterectomies (R$794,680.40). CONCLUSIONS Total abdominal hysterectomies had the highest overall costs mainly because it was the most commonly performed technique. Mortality rates were greatest in subtotal abdominal hysterectomies; this, however, may be due to bias related to missing data in our database.

Resumo em Português:

RESUMO OBJETIVO Testar se há associação entre posição socioeconômica da infância e medidas de índice de massa corporal, circunferência da cintura e presença de obesidade geral e abdominal na vida adulta. MÉTODOS Análise transversal em estudo de coorte de base populacional, incluindo amostra de adultos (22–63 anos) residentes em Florianópolis, Sul do Brasil. A posição socioeconômica da infância foi analisada por meio da escolaridade dos pais e mães dos participantes. Estatura, peso e circunferência da cintura foram aferidos por entrevistadores previamente treinados. Foram empregadas regressões linear e logística com ajuste para fatores de confusão, e estratificação dos dados segundo sexo. RESULTADOS Dos 1.222 adultos avaliados, 20,4% (IC95% 18,1–22,8) apresentaram obesidade geral e 24,8% (IC95% 22,4–27,4), obesidade abdominal. As médias de índice de massa corporal e circunferência da cintura entre mulheres foram, respectivamente, 1,2 kg/m2 (IC95% -2,3– -0,04) e 2,8 cm (IC95% -5,3– -0,2) menores entre aquelas de maior posição socioeconômica na infância. Entre os homens, a circunferência da cintura foi 3,9 cm (IC95% 1,0–6,8) maior nos indivíduos de maior posição socioeconômica na infância. Em relação à obesidade, mulheres de maior posição socioeconômica na infância tiveram menores chances de obesidade abdominal (OR = 0,56; IC95% 0,34–0,90), não tendo sido observada tal associação entre os homens. CONCLUSÕES A posição socioeconômica na infância tem influência sobre índice de massa corporal, circunferência da cintura e obesidade em adultos, com diferença na direção da associação conforme o sexo. A maior posição socioeconômica entre os homens e a menor posição socioeconômica entre as mulheres estiveram associadas aos maiores indicadores de adiposidade.

Resumo em Inglês:

ABSTRACT OBJECTIVE To test whether there is an association between socioeconomic status in childhood and measures of body mass index, waist circumference and the presence of overall and abdominal obesity in adult life. METHODS A cross-sectional analysis of a population-based cohort study, including a sample of adults (22–63 years old) living in Florianópolis, Southern Brazil. The socioeconomic status in childhood was analyzed through the education level of the participant’s parents. Height, weight and waist circumference were measured by previously trained interviewers. Linear and logistic regressions with adjustment for confounding factors and stratification of data according to gender were used. RESULTS Of the 1,222 adults evaluated, 20.4% (95%CI 18.1–22.8) presented overall obesity and 24.8% (95%CI 22.4–27.4), abdominal obesity. The body mass index and waist circumference averages among women were, respectively, 1.2 kg/m2 (95%CI -2.3– -0.04) and 2.8 cm (95%CI -5.3– -0.2) lower among those with higher socioeconomic status in childhood. Among men, waist circumference was 3.9 cm (95%CI 1.0–6.8) higher in individuals with higher socioeconomic status in childhood. Regarding obesity, women of higher socioeconomic status in childhood had lower odds of abdominal obesity (OR = 0.56, 95%CI 0.34–0.90), and no such association was observed among men. CONCLUSIONS The socioeconomic status in childhood influences body mass index, waist circumference and obesity in adults, with a difference in the direction of association according to gender. The higher socioeconomic status among men and the lower socioeconomic status among women were associated with higher adiposity indicators.

Resumo em Português:

RESUMO OBJETIVO Avaliar a prevalência e os fatores associados à ocorrência de quedas em idosos. MÉTODOS Estudo transversal com amostra representativa de 1.451 idosos residentes na zona urbana de Pelotas, RS, em 2014. Foi realizada análise descritiva dos dados e apresentada a prevalência de quedas no último ano. A análise de fatores demográficos, socioeconômicos, comportamentais e de saúde associados ao desfecho foi realizada por meio de regressão de Poisson com ajuste para variância robusta conforme modelo hierárquico. As variáveis foram ajustadas entre si dentro de cada nível e para as de nível superior. Aquelas com p ≤ 0,20 foram mantidas no modelo para controle de confusão e aquelas com p < 0,05 foram consideradas associadas ao desfecho. RESULTADOS A prevalência de quedas em idosos no último ano foi de 28,1% (IC95% 25,9–30,5), e a maioria ocorreu na própria residência do idoso. Entre os idosos que sofreram queda, 51,5% (IC95% 46,6–56,4) tiveram uma única queda e 12,1% (IC95% 8,9–15,3) tiveram fratura como consequência, sendo a de membros inferiores a mais relatada. A prevalência de quedas foi maior em mulheres, idosos com idade avançada, de menor renda e escolaridade, com incapacidade funcional para atividades instrumentais e portadores de enfermidades como diabetes, doença cardíaca e artrite. CONCLUSÕES A ocorrência de quedas atingiu quase um terço dos idosos, e a prevalência foi mais elevada em segmentos específicos da população em questão. Cerca de 12% dos idosos que caíram, fraturaram algum osso. Os fatores associados à ocorrência de quedas identificados neste estudo poderão nortear medidas que visem sua prevenção na população de idosos.

Resumo em Inglês:

ABSTRACT OBJECTIVE Evaluate the prevalence and the factors associated with the occurrence of falls among older adults. METHODS A cross-sectional study with a representative sample of 1,451 elderly residents in the urban area of Pelotas, RS, in 2014. A descriptive analysis of the data was performed and the prevalence of falls in the last year was presented. The analysis of demographic, socioeconomic, behavioral and health factors associated with the outcome was performed using Poisson regression with adjustment for robust variance according to the hierarchical model. The variables were adjusted to each other within each level and for the higher level. Those with p ≤ 0.20 were maintained in the model for confounding control and those with p < 0.05 were considered to be associated with the outcome. RESULTS The prevalence of falls among older adults in the last year was 28.1% (95%CI 25.9–30.5), and most occurred in the person’s own residence. Among the older adults who fell, 51.5% (95%CI 46.6–56.4) had a single fall and 12.1% (95%CI 8.9–15.3) had a fracture as a consequence, usually in the lower limbs. The prevalence of falls was higher in women, adults of advanced age, with lower income and schooling level, with functional incapacity for instrumental activities, and patients with diseases such as diabetes, heart disease, and arthritis. CONCLUSIONS The occurrence of falls reached almost a third of the older adults, and the prevalence was higher in specific segments of the population in question. About 12% of the older adults who fell fractured some bone. The factors associated with the occurrence of falls identified in this study may guide measures aimed at prevention in the older adult population.

Resumo em Português:

RESUMO OBJETIVO Sistematizar e analisar evidências levantadas por estudos de natureza qualitativa que abordam a percepção do ACS sobre seu trabalho. MÉTODOS Revisão sistemática, tipo metassíntese, sobre o trabalho dos agentes comunitários de saúde, realizada a partir da Biblioteca Virtual em Saúde utilizando os descritores “Agente Comunitário de Saúde” e “Trabalho”. A estratégia foi construída cruzando descritores, usando o operador booleano “AND”, e filtrando artigos brasileiros, publicados de 2004 a 2014, resultando em 129 artigos identificados. Foram excluídos artigos de pesquisas quantitativas ou quanti-qualitativas, ensaios, debates, revisões da literatura, relatos de experiências e pesquisas que não incluíram os ACS como sujeitos. Aplicando esses critérios, foram selecionados e analisados 33 estudos que possibilitaram: identificação de temas comuns e diferenças entre eles; agrupamento de principais conclusões; classificação de temas e interpretação de conteúdo. RESULTADOS A análise resultou em três unidades temáticas: Características do trabalho dos agentes comunitários de saúde; Problemas relacionados ao trabalho dos agentes comunitários de saúde; Aspectos positivos do trabalho dos agentes comunitários de saúde. Sobre as características, evidenciou-se que o trabalho dos agentes comunitários de saúde é permeado pelas dimensões política e social do trabalho em saúde com uso predominante de tecnologias leves, tendo como principal insumo o conhecimento que esse profissional obtém junto às famílias, sendo a visita domiciliar o palco para o desenvolvimento desse contato. Sobre os problemas no trabalho dos agentes comunitários de saúde, foram identificados: falta de limites em suas atribuições; condições precárias; obstáculos na relação com a comunidade e equipes; fragilidade na formação profissional e burocratização. Os aspectos positivos identificados foram: reconhecimento do trabalho pelas famílias e resolutividade, formação de vínculo, trabalho junto aos pares e perto da residência. CONCLUSÕES Essa revisão teceu um panorama sobre as dificuldades e aspectos positivos que se apresentam no cotidiano de trabalho dos agentes comunitários de saúde. Frente a isso, levantou dois desafios. O primeiro se refere à necessidade de apropriação dos resultados das pesquisas pelos formuladores de políticas públicas e, o segundo, à necessidade de investimento em estudos que se voltem para engendrar soluções para as dificuldades enfrentadas pelos agentes comunitários de saúde no seu trabalho.

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ABSTRACT OBJECTIVE To systematize and analyze the evidence from qualitative studies that address the perception of Brazilian Community Health Agents about their work. METHODS This is a systematic review of the meta-synthesis type on the work of community health agents, carried out from the Virtual Health Library using the descriptors “Agente Comunitário de Saúde” and “Trabalho”, in Portuguese. The strategy was constructed by crossing descriptors, using the Boolean operator “AND”, and filtering Brazilian articles, published from 2004 to 2014, which resulted in 129 identified articles. We removed quantitative or quanti-qualitative research articles, essays, debates, literature reviews, reports of experiences, and research that did not include Brazilian Community Health Agents as subjects. Using these criteria, we selected and analyzed 33 studies that allowed us to identify common subjects and differences between them, to group the main conclusions, to classify subjects, and to interpret the content. RESULTS The analysis resulted in three thematic units: characteristics of the work of community health agents, problems related to the work of community health agents, and positive aspects of the work of community health agents. On the characteristics, we could see that the work of the community health agents is permeated by the political and social dimensions of the health work with predominant use of light technologies. The main input is the knowledge that this professional obtains with the contact with families, which is developed with home visits. On the problems in the work of community health agents, we could identify the lack of limits in their attributions, poor conditions, obstacles in the relationship with the community and teams, weak professional training, and bureaucracy. The positive aspects we identified were the recognition of the work by families, resolution, bonding, work with peers, and work close to home. CONCLUSIONS This review provided an overview of the difficulties and positive aspects that are present in the daily work of community health agents. Given this, we have raised two challenges. The first one refers to how public policy makers need to appropriation the research results and the second one refers to the need to invest in studies that are designed to generate solutions for the difficulties faced by community health agents in their work.

Resumo em Português:

RESUMO OBJETIVO Analisar a execução do Programa Nacional de Alimentação Escolar como política de segurança alimentar e nutricional em escolas públicas. MÉTODOS Estudo transversal, com abordagem quantitativa e qualitativa, realizado com 268 escolares de oito a nove anos da rede pública de ensino em Viçosa, MG, em 2015. Foram realizadas entrevistas por meio de questionários semiestruturados com as crianças, os pais, merendeiras, nutricionistas, extensionista da Empresa de Assistência Técnica e Extensão Rural e presidente do Conselho de Alimentação Escolar. Para analisar a execução do Programa Nacional de Alimentação Escolar em Viçosa, foi avaliada a pesagem direta dos alimentos servidos nas escolas, utilizando-se balanças mecânicas com capacidade de até 10 kg, e a percepção dos atores sociais envolvidos na execução do Programa Nacional de Alimentação Escolar. As crianças foram questionadas sobre a aceitação e adesão da alimentação ofertada, além do hábito de levar lanches de casa. Os pais relataram o conhecimento sobre o Programa e o Conselho de Alimentação Escolar. A análise qualitativa foi constituída pela análise de conteúdo e a quantitativa pelo Teste do Qui-quadrado, Exato de Fisher e Mann-Whitney. Adotou-se significância estatística de 5% para a análise quantitativa. RESULTADOS As crianças relataram baixa adesão à alimentação escolar e a maior parte costumava levar lanche de casa. Foram identificadas irregularidades na execução do Programa Nacional de Alimentação Escolar, como: inadequação do número de nutricionistas, suspensão das reuniões do Conselho, inadequação da infraestrutura nas áreas de preparo e de distribuição das refeições, falta de capacitação das merendeiras, não adequação nutricional da alimentação ofertada e ausência de ações de educação alimentar e nutricional. O Programa atendeu as recomendações de compra dos alimentos provenientes da agricultura familiar. CONCLUSÕES O Programa Nacional de Alimentação Escolar apresentou muitas irregularidades em Viçosa. É importante o monitoramento dos problemas identificados para melhor reformulação e planejamento do Programa, visando à garantia da segurança alimentar e nutricional das crianças atendidas.

Resumo em Inglês:

ABSTRACT OBJECTIVE To analyze the implementation of the Brazilian National School Feeding Program as a food and nutritional security policy in public schools. METHODS This a cross-sectional study, with a quantitative and qualitative approach, carried out with 268 schoolchildren aged eight to nine years from the public school system of Viçosa, state of Minas Gerais, Brazil, in 2015. Interviews were carried out using semi-structured questionnaires with the children, parents, cooks, nutritionists, trainer of the Technical Assistance and Rural Extension Company, and president of the School Feeding Council. In order to analyze the implementation of the National School Feeding Program in Viçosa, we evaluated the direct weighing of the food served in the schools using mechanical balances with a capacity of up to 10 kg and the perception of the social players involved in the implementation of the National School Feeding Program. The children were questioned about the acceptance of and adherence to the food offered, in addition to the habit of bringing food from home. Parents reported knowledge about the School Feeding Program and Council. The qualitative analysis consisted of content analysis and quantitative analysis using the chi-square test, Fisher’s exact test, and Mann-Whitney test. We adopted the statistical significance of 5% for quantitative analysis. RESULTS Children reported low adherence to the school feeding program and most of them used to bring food from home. Irregularities were identified in the implementation of the National School Feeding Program, such as: inadequate number of nutritionists, suspension of Council meetings, inadequate infrastructure in the areas of preparation and distribution of meals, lack of training of cooks, lack of nutritional adequacy of the food offered, and lack of actions on food and nutritional education. The Program complied with the recommendations for purchasing food from family farms. CONCLUSIONS The National School Feeding Program presented many irregularities in Viçosa. It is important to monitor the problems identified for better reformulation and planning of the Program, in order to guarantee the food and nutritional security of the children served.

Resumo em Português:

RESUMO OBJETIVO Descrever o tamanho das porções de bebidas consumidas e avaliar sua associação com excesso de peso no Brasil. MÉTODOS Utilizou-se dados do Inquérito Nacional de Alimentação, incluindo indivíduos com dois dias de registro alimentar, acima de 20 anos de idade (n = 24.527 indivíduos). As bebidas foram categorizadas em seis grupos: refrigerante; suco; refresco; bebida alcóolica; leite; e café ou chá. Estimou-se a porção média por ocasião de consumo para cada grupo e avaliou-se, por meio de regressão linear, a associação entre tamanho da porção por grupo e as variáveis idade, sexo, renda e estado nutricional. A associação entre tamanho da porção e excesso de peso foi testada por meio de regressão de Poisson, ajustada por idade, sexo, renda e ingestão total de energia. RESULTADOS As bebidas com maior frequência de consumo no Brasil foram café e chá, seguidas dos sucos, refrigerantes e leite. As bebidas alcóolicas apresentaram maior média no tamanho da porção consumida, seguidas dos refrigerantes, sucos, refrescos e leite. O tamanho da porção mostrou associação positiva com excesso de peso somente no grupo dos refrigerantes (RP = 1,19; IC95% 1,10–1,27), e bebidas alcoólicas (RP = 1,20; IC95% 1,11–1,29), independentemente da idade, sexo, renda e ingestão total de energia. CONCLUSÕES Bebidas alcoólicas e refrigerantes apresentaram as maiores médias no tamanho da porção e associação positiva com excesso de peso. Intervenções de saúde pública devem abranger a questão do tamanho das porções oferecidas aos consumidores, desencorajando o consumo de grandes porções, principalmente das bebidas adicionadas de açúcar e de baixo teor nutricional.

Resumo em Inglês:

ABSTRACT OBJECTIVE To describe the beverage portion size consumed and to evaluate their association with excess weight in Brazil. METHODS We used data from the National Dietary Survey, which included individuals with two days of food record aged over 20 years (n = 24,527 individuals). The beverages were categorized into six groups: soft drink, 100% fruit juice, fruit drink, alcoholic beverage, milk, and coffee or tea. We estimated the average portion consumed for each group and we evaluated, using linear regression, the association between portion size per group and the variables of age, sex, income, and nutritional status. We tested the association between portion size and excess weight using Poisson regression, adjusted for age, sex, income, and total energy intake. RESULTS The most frequently consumed beverages in Brazil were coffee and tea, followed by 100% fruit juices, soft drinks, and milk. Alcoholic beverages presented the highest average in the portion size consumed, followed by soft drinks, 100% fruit juice, fruit drink, and milk. Portion size showed positive association with excess weight only in the soft drink (PR = 1.19, 95%CI 1.10–1.27) and alcoholic beverage groups (PR = 1.20, 95%CI, 1.11–1.29), regardless of age, sex, income, and total energy intake. CONCLUSIONS Alcoholic beverages and soft drinks presented the highest averages in portion size and positive association with excess weight. Public health interventions should address the issue of portion sizes offered to consumers by discouraging the consumption of large portions, especially sweetened and low nutritional beverages.

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RESUMO OBJETIVO Quantificar as despesas domiciliares per capita e estimar o percentual de domicílios brasileiros que gastaram com planos exclusivamente odontológicos. MÉTODOS Foram analisados dados de 55.970 domicílios que participaram da Pesquisa de Orçamentos Familiares em 2008–2009. Os gastos domiciliares anuais per capita com planos exclusivamente odontológicos (empresarial e particular) foram analisados segundo os estados da federação e as características socioeconômicas e demográficas dos domicílios (sexo, idade, cor da pele e escolaridade do chefe do domicílio, renda familiar e presença de idoso no domicílio). RESULTADOS Apenas 2,5% dos domicílios brasileiros relataram gastos com planos exclusivamente odontológicos. O valor per capita despendido somou em média R$5,10, sendo a maior parte composta por planos odontológicos particulares (R$4,70). Entre as caraterísticas do domicílio, maior escolaridade e renda estiveram associadas com maior gasto. São Paulo foi o estado com maior gasto domiciliar per capita (R$10,90) e maior prevalência de domicílios com dispêndios (4,6%), enquanto Amazonas e Tocantins apresentaram os menores valores, ambos com gasto inferior a R$1,00 e com menos de 0,1% de domicílios, respectivamente. CONCLUSÕES Apenas uma pequena parcela dos domicílios brasileiros desembolsa com planos exclusivamente odontológicos. O mercado de odontologia suplementar na assistência em saúde bucal abrange uma restrita parcela da população brasileira.

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ABSTRACT OBJECTIVE To quantify the household expenditure per capita and to estimate the percentage of Brazilian households that have spent with dental insurance. METHODS We analyzed data from 55,970 households that participated in the research Pesquisa de Orçamentos Familiares in 2008–2009. We have analyzed the annual household expenditure per capita with dental insurance (business and private) according to the Brazilian states and the socioeconomic and demographic characteristics of the households (sex, age, race, and educational level of the head of the household, family income, and presence of an older adult in the household). RESULTS Only 2.5% of Brazilian households have reported spending on dental insurance. The amount spent per capita amounted to R$5.10 on average, most of which consisted of private dental insurance (R$4.70). Among the characteristics of the household, higher educational level and income were associated with higher spending. São Paulo was the state with the highest household expenditure per capita (R$10.90) and with the highest prevalence of households with expenditures (4.6%), while Amazonas and Tocantins had the lowest values, in which both spent less than R$1.00 and had a prevalence of less than 0.1% of households, respectively. CONCLUSIONS Only a small portion of the Brazilian households has dental insurance expenditure. The market for supplementary dentistry in oral health care covers a restricted portion of the Brazilian population.

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RESUMEN OBJETIVO Analizar la carga epidemiológica y económica de la demanda de servicios de salud por diabetes e hipertensión en México. MÉTODOS Investigación evaluativa basada en un estudio de series de tiempo que tomó como universo de estudio la población asegurada y no asegurada que demanda servicios de salud a las tres principales instituciones del Sistema de Salud en México: Secretaría de Salud, Instituto Mexicano del Seguro Social, e Instituto de Servicios y Seguridad Social para los Trabajadores del Estado. El método de costeo tomó como base las técnicas de instrumentación y de consenso por manejo de caso promedio. Para estimar los cambios epidemiológicos y requerimientos financieros, se integró una serie de tiempos de casos observados para diabetes e hipertensión 1994–2013. Se desarrollaron modelos probabilísticos basados en la técnica de Box-Jenkins para el periodo 2013–2018 con intervalos del 95% de confianza y p < 0.05. RESULTADOS Comparando resultados de 2013 versus 2018, en las cinco regiones, se observaron diferentes tendencias incrementales de 14%–17% en cambios epidemiológicos y de 58%–66% en la carga económica para ambas enfermedades. CONCLUSIONES Si los factores de riesgo y los diferentes modelos de atención permanecieran como están actualmente en las tres instituciones de análisis, las consecuencias financieras serían de mayor impacto para el Instituto Mexicano del Seguro Social, siguiendo en orden de importancia el Instituto de Servicios y Seguridad Social para los Trabajadores del Estado y finalmente para la Secretaría de Salud. Los requerimientos financieros para ambas enfermedades representarán aproximadamente del 13%–15% del presupuesto total asignado para población no asegurada y el 15%–17% para población asegurada dependiendo de la región.

Resumo em Inglês:

ABSTRACT OBJECTIVE To analyze the epidemiological and economic burden of the health services demand due to diabetes and hypertension in Mexico. METHODS Evaluation study based on a time series study that had as a universe of study the assured and uninsured population that demands health services from the three main institutions of the Health System in Mexico: The Health Department, the Mexican Institute of Social Security, and Institute of Services and Social Security for State Workers. The financing method was based on instrumentation and consensus techniques for medium case management. In order to estimate the epidemiological changes and financial requirements, a time series of observed cases for diabetes and hypertension 1994–2013 was integrated. Probabilistic models were developed based on the Box-Jenkins technique for the period of 2013–2018 with 95% confidence intervals and p < 0.05. RESULTS Comparing results from 2013 versus 2018, in the five regions, different incremental trends of 14%–17% in epidemiological changes and 58%-66% in the economic burden for both diseases were observed. CONCLUSIONS If the risk factors and the different models of care remained as they currently are in the three institutions analyzed, the financial consequences would be of greater impact for the Mexican Institute of Social Security, following in order of importance the Institute of Services and Social Security for State Workers and lastly the Health Department. The financial needs for both diseases will represent approximately 13%–15% of the total budget allocated to the uninsured population and 15%–17% for the population insured depending on the region.

Resumo em Português:

RESUMO OBJETIVO Avaliar a validade de construto de uma lista com oito Eventos de Vida Estressantes em gestantes. MÉTODOS Foi conduzido um estudo transversal com 1.446 gestantes em São Luís, MA, e 1.364 em Ribeirão Preto, SP (coorte BRISA), de fevereiro de 2010 a junho de 2011. Na análise fatorial exploratória, utilizou-se a rotação oblíqua promax e para o cálculo da consistência interna, a confiabilidade composta. A validade de construto foi determinada por meio da análise fatorial confirmatória com o método de estimação dos mínimos quadrados ponderados ajustados pela média e variância. RESULTADOS O modelo com o melhor ajuste na análise exploratória foi o que reteve três fatores com uma variância acumulada de 61,1%. O modelo com um fator não obteve um bom ajuste em ambas as amostras na análise confirmatória. O modelo com três fatores denominado Eventos de Vida Produtores de Estresse apresentou um bom ajuste (RMSEA < 0,05; CFI/TLI > 0,90) para as duas amostras. CONCLUSÕES Os Eventos de Vida Produtores de Estresse constituem um construto de segunda ordem com três dimensões relacionadas à saúde, aos aspectos pessoais e financeiros e à violência. Este estudo encontrou evidências que confirmam a validade de construto de uma lista de eventos estressores, intitulado Inventário de Eventos de Vida Produtores de Estresse.

Resumo em Inglês:

ABSTRACT OBJECTIVE Evaluate the construct validity of a list of eight Stressful Life Events in pregnant women. METHODS A cross-sectional study was conducted with 1,446 pregnant women in São Luís, MA, and 1,364 pregnant women in Ribeirão Preto, SP (BRISA cohort), from February 2010 to June 2011. In the exploratory factorial analysis, the promax oblique rotation was used and for the calculation of the internal consistency, we used the compound reliability. The construct validity was determined by means of the confirmatory factorial analysis with the method of estimation of weighted least squares adjusted by the mean and variance. RESULTS The model with the best fit in the exploratory analysis was the one that retained three factors with a cumulative variance of 61.1%. The one-factor model did not obtain a good fit in both samples in the confirmatory analysis. The three-factor model called Stress-Producing Life Events presented a good fit (RMSEA < 0.05; CFI/TLI > 0.90) for both samples. CONCLUSIONS The Stress-Producing Life Events constitute a second order construct with three dimensions related to health, personal and financial aspects and violence. This study found evidence that confirms the construct validity of a list of stressor events, entitled Stress-Producing Life Events Inventory.

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RESUMO OBJETIVO Determinar os itens do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica que melhor avaliam a capacidade de oferta de cuidados em saúde mental. MÉTODOS Estudo transversal efetuado por meio do Modelo de Resposta Gradual da Teoria da Resposta ao Item, utilizando dados secundários do segundo ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica, tendo sido avaliadas 30.523 equipes de atenção básica no período de 2013 a 2014. A consistência interna, a correlação entre os itens e dos itens com o escore total foram testadas usando os coeficientes alfa de Cronbach, correlação de Spearman e ponto bisserial, respectivamente. Foram testados os pressupostos de unidimensionalidade e independência local dos itens. Utilizaram-se como uma das formas de apresentação dos resultados as nuvens de palavras. RESULTADOS Programar a agenda de acordo com a estratificação de risco, manter registro dos casos mais graves de usuários em sofrimento psíquico e ofertar algum atendimento em grupo foram os itens com maior capacidade de discriminação. Ofertar alguma modalidade de atendimento em grupo e ofertar ações educativas e de promoção de saúde mental foram os itens que requereram maior nível de oferta de cuidados em saúde mental no parâmetro de locação. O coeficiente alfa de Cronbach total foi 0,87. Realizar o registro dos casos mais graves de usuários em sofrimento psíquico e programar a agenda de acordo com a estratificação de risco foram os itens que obtiveram maior correlação com o escore total. Os escores finais obtidos oscilaram entre -2,07 (mínimo) e 1,95 (máximo). CONCLUSÕES São aspectos relevantes na discriminação da capacidade de ofertar cuidados em saúde mental pelas equipes de atenção básica: a estratificação do risco para gestão do cuidado, o acompanhamento dos casos mais graves, o atendimento em grupo e as ações preventivas e de promoção da saúde.

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ABSTRACT OBJECTIVE To determine the items of the Brazilian National Program for Improving Access and Quality of Primary Care that better evaluate the capacity to provide mental health care. METHODS This is a cross-sectional study carried out using the Graded Response Model of the Item Response Theory using secondary data from the second cycle of the National Program for Improving Access and Quality of Primary Care, which evaluates 30,523 primary care teams in the period from 2013 to 2014 in Brazil. The internal consistency, correlation between items, and correlation between items and the total score were tested using the Cronbach’s alpha, Spearman’s correlation, and point biserial coefficients, respectively. The assumptions of unidimensionality and local independence of the items were tested. Word clouds were used as one way to present the results. RESULTS The items with the greatest ability to discriminate were scheduling of the agenda according to risk stratification, keeping of records of the most serious cases of users in psychological distress, and provision of group care. The items that required a higher level of mental health care in the parameter of location were the provision of any type of group care and the provision of educational and mental health promotion activities. Total Cronbach’s alpha coefficient was 0.87. The items that obtained the highest correlation with total score were the recording of the most serious cases of users in psychological distress and scheduling of the agenda according to risk stratification. The final scores obtained oscillated between -2.07 (minimum) and 1.95 (maximum). CONCLUSIONS There are important aspects in the discrimination of the capacity to provide mental health care by primary health care teams: risk stratification for care management, follow-up of the most serious cases, group care, and preventive and health promotion actions.

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RESUMO OBJETIVO Descrever a epidemiologia da dengue em cidade de médio porte do estado de São Paulo. MÉTODOS Foram obtidas informações sobre os casos notificados e confirmados de dengue em Araraquara, SP, entre 1991 e 2015, como sorotipos circulantes, casos graves e óbitos, faixa etária, sexo, entre outras. Também foram levantadas as informações climáticas e de infestação pelo vetor. Essas variáveis foram trabalhadas descritivamente, utilizando-se medidas estatísticas como frequências, médias, mínimo e máximo. Calcularam-se taxas de incidência de dengue segundo mês, ano, idade e sexo, e série histórica de casos de dengue, infestação e variáveis climáticas. RESULTADOS Foram confirmados 16.431 casos de dengue entre 1991 e 2015. O maior número de notificações foi registrado em 2015 (7.811 casos). De forma geral, a faixa etária com o maior número de notificações encontra-se entre 20 e 59 anos. As maiores incidências, geralmente entre março e maio, ocorreram após o aumento da pluviosidade e infestação, em janeiro. CONCLUSÕES Os altos níveis de infestação que aumentam com as chuvas refletem-se nas taxas de incidência da doença. É fundamental conhecer a epidemiologia da dengue em cidades de médio porte. Seus resultados podem ser estendidos para doenças como Zika e Chikungunya (transmitidas pelo mesmo vetor e notificadas na cidade). A intensificação dos esforços de vigilâncias em períodos que precedem as epidemias poderia ser uma estratégia a ser considerada para o controle da dispersão viral.

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ABSTRACT OBJECTIVE To describe the epidemiology of dengue in a medium-sized city in the state of São Paulo. METHODS Data, such as circulating serotypes, severe cases and deaths, age group, sex, among others, were obtained on reported and confirmed dengue cases in Araraquara, state of São Paulo, between 1991 and 2015. Climatic and infestation data were also analyzed. These variables were evaluated descriptively, using statistical measures such as frequencies, averages, minimum and maximum. Dengue incidence rates were calculated according to month, year, age and sex, and time series of dengue cases, infestation, and climatic variables. RESULTS Approximately 16,500 cases of dengue fever were reported between 1991 and 2015. The highest number of reports was recorded in 2015 (7,811 cases). In general, the age group with the highest number of reports is between 20 and 59 years old. The highest incidences, generally between March and May, occurred after the increase in rainfall and infestation in January. CONCLUSIONS Increased levels of infestation due to rainfall are reflected in incidence rates of the disease. It is fundamental to know the epidemiology of dengue in medium-sized cities. Such information can be extended to diseases such as Zika and Chikungunya, which are transmitted by the same vector and were reported in the city. The intensification of surveillance efforts in periods before epidemics could be a strategy to be considered to control the viral spread.

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RESUMO OBJETIVO Analisar, segundo gênero, as tendências temporais dos coeficientes de detecção de casos novos de hanseníase na população geral e em crianças, do coeficiente de grau 2 de incapacidade física e da proporção de casos multibacilares no estado da Bahia, no período de 2001 a 2014. MÉTODOS Estudo de série temporal baseado em dados epidemiológicos relativos à hanseníase oriundos do Sistema de Informação de Agravos de Notificação. A análise de tendência temporal incluiu modelos de regressão de Poisson por pontos de inflexão (Joinpoint), considerando-se a dimensão de gênero. RESULTADOS Dos 40.054 casos notificados no período, verificou-se tendência de redução no coeficiente de detecção geral (Average Annual Percent Change [AAPC] = -0,4; IC95% -2,8–1,9) e aumento em menores de 15 anos sem significância estatística (AAPC = 0,2; IC95% -3,9–4,5). Para o coeficiente de detecção com grau 2 de incapacidade física, a tendência foi de aumento significativo (AAPC = 4,0; IC95% 1,3–6,8), assim como nos casos multibacilares (AAPC = 2,2; IC95% 0,1–4,3). A análise estratificada por gênero indicou tendência de redução dos coeficientes de detecção entre as mulheres e de manutenção entre os homens, sem significância estatística. Em relação ao coeficiente de detecção em menores de 15 anos, a tendência de redução é mais acentuada nas mulheres do que entre os homens. As mulheres apresentaram tendência mais acentuada de aumento na proporção de casos multibacilares e do coeficiente de detecção de grau 2 de incapacidade. CONCLUSÕES O estado da Bahia mantém alta endemicidade, transmissão ativa, diagnóstico tardio e provável endemia oculta de hanseníase. Há um padrão diferencial segundo gênero, tornando central o diagnóstico e tratamento oportuno com estratégias diferenciadas para os homens, sem desconsiderar a situação entre as mulheres.

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ABSTRACT OBJECTIVE To analyze, stratifield by gender, trends of the new case leprosy detection rates in the general population and in children; of grade 2 disability, and of proportion of multibacillary cases, in the state of Bahia, Brazil from 2001 to 2014. METHODS A time series study based on leprosy data from the National Information System for Notifiable Diseases. The time trend analysis included Poisson regression models by infection points (Joinpoint) stratified by gender. RESULTS There was a total of 40,054 new leprosy cases with a downward trend of the overall detection rate (Average Annual Percent Change [AAPC = -0.4, 95%CI -2.8–1.9] and a non-significant increase in children under 15 years (AAPC = 0.2, 95%CI -3.9–4.5). The proportion of grade 2 disability among new cases increased significantly (AAPC = 4.0, 95%CI 1.3–6.8), as well as the proportion of multibacillary cases (AAPC = 2.2, 95%CI 0.1–4.3). Stratification by gender showed a downward trend of detection rates in females and no significant change in males; in females, there was a more pronounced upward trend of the proportion of multibacillary and grade 2 disability cases. CONCLUSIONS Leprosy is still highly endemic in the state of Bahia, with active transmission, late diagnosis, and a probable hidden endemic. There are different gender patterns, indicating the importance of early diagnosis and prompt treatment, specifically in males without neglecting the situation among females.

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ABSTRACT Precision medicine has been announced as a new health revolution. The term precision implies more accuracy in healthcare and prevention of diseases, which could yield substantial cost savings. However, scientific debate about precision medicine is needed to avoid wasting economic resources and hype. In this commentary, we express the reasons why precision medicine cannot be a health revolution for population health. Advocates of precision medicine neglect the limitations of individual-centred, high-risk strategies (reduced population health impact) and the current crisis of evidence-based medicine. Overrated “precision medicine” promises may be serving vested interests, by dictating priorities in the research agenda and justifying the exorbitant healthcare expenditure in our finance-based medicine. If societies aspire to address strong risk factors for non-communicable diseases (such as air pollution, smoking, poor diets, or physical inactivity), they need less medicine and more investment in population prevention strategies.

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ABSTRACT OBJECTIVE This systematic review study aimed to assess the evidence available for the association between breastfeeding and behavior disorders in childhood and adolescence. METHODS The search was carried out in the PubMed, Lilacs, and PsycINFO databases up to December 2016. Inclusion criteria were as follows: prospective, retrospective and cross-sectional studies assessing the association between breastfeeding and behavior disorders in childhood or adolescence, using psychometric tests, carried out in humans and published in Portuguese, English, or Spanish. The search was performed in several stages by two independent researchers using pre-established criteria. RESULTS Eighteen studies met the inclusion criteria. Breastfeeding for a period equal to or higher than three or four months seemed to be inversely associated with total behavior and conduct disorders in childhood; however, the association remains unclear for other behavior disorders. Only four studies assessed behavior disorders in adolescence, and when an association was found, it was likely to be positive. The duration of breastfeeding seemed to be more important than the exclusive or non-exclusive pattern of breastfeeding. CONCLUSIONS Breastfed children for at least three to four months had fewer total behavior and conduct disorders in childhood. Further studies are needed to better understand this association, particularly in adolescence and involving other behavioral profiles.

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RESUMO OBJETIVO Estimar a prevalência de tuberculose ativa e de infecção latente da tuberculose entre funcionários contatos e não contatos de detentos, e investigar fatores associados à infecção latente da tuberculose nesta população. MÉTODOS Estudo observacional do tipo transversal, realizado no período de 2012 a 2015, em funcionários de diferentes unidades prisionais do município de Franco da Rocha, SP. Consistiu na aplicação de um questionário, aplicação e leitura da prova tuberculínica, baciloscopia e cultura dos escarros e exame radiológico. A associação entre as variáveis qualitativas foi calculada pelo teste qui-quadrado de Pearson e os fatores sociodemográficos e clínico-epidemiológicos relacionados à infecção latente da tuberculose foram avaliados pela regressão logística com o cálculo das odds ratios (OR) e seus respectivos intervalos com 95% de confiança (IC95%). RESULTADOS Foram examinados 1.059 funcionários, sendo 657 (62,0%) de penitenciárias, 249 (23,5%) de unidades da Fundação CASA e 153 (14,5%) de hospitais de custódia e tratamento psiquiátrico. Foi aplicada e lida a prova tuberculínica em 945 (89,2%) profissionais. Desses, 797 (84,3%) eram contatos de detentos e 148 (15,7%) não eram. Entre funcionários das penitenciárias, os fatores associados com a infecção latente da tuberculose foram os seguintes: ter contato com detento (OR = 2,12; IC95% 1,21–3,71); ser do sexo masculino (OR = 1,97; IC95% 1,19–3,27); estar na faixa etária entre 30 e 39 anos (OR = 2,98; IC95% 1,34–6,63), 40 a 49 anos (OR = 4,32; IC95% 1,94–9,60) e 50 a 59 anos (OR = 3,98; IC95% 1,68–9,43); ser da cor ou raça não branca (OR = 1,89; IC95% 1,29–2,78); e ser fumante (OR = 1,64; IC95% 1,05–2,55). Não houve exame positivo na baciloscopia e na cultura. Dos 241 (22,8%) profissionais que realizaram o exame radiológico, 48 (19,9%) apresentaram alterações, dos quais 11 eram suspeitos de tuberculose. CONCLUSÕES Os funcionários das penitenciárias que têm contato direto com os detentos têm 2,12 vezes mais chance de se infectar pelo Mycobacterium tuberculosis no âmbito de trabalho e, consequentemente, de adoecer por tuberculose, devendo ser alvos de ações de prevenção e controle da doença.

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ABSTRACT OBJECTIVE Estimate the prevalence of active tuberculosis and latent tuberculosis infection among the staff that is in contact and the staff that is not in contact with prisoners, and investigate factors associated with latent tuberculosis infection in this population. METHODS Observational cross-sectional study, conducted from 2012 to 2015, in employees of different prison units in the municipality of Franco da Rocha, SP. It consisted of the application of a questionnaire, application and reading of the tuberculin test, sputum smear microscopy, sputum culture, and radiological examination. The association between the qualitative variables was calculated by the Pearson's chi-squared test. The sociodemographic and clinical-epidemiological factors related to the latent tuberculosis infection were evaluated by the logistic regression with the odds ratios (OR) calculation and their respective intervals with 95% of confidence (95%CI). RESULTS A total of 1,059 employees were examined, 657 (62.0%) of prisons, 249 (23.5%) of CASA Foundation units and 153 (14.5%) of custodial and psychiatric treatment hospitals. The tuberculin test was applied and read for 945 (89.2%) professionals. Of these, 797 (84.3%) were contacts of detainees and 148 (15.7%) were not. Among prison staff, the factors associated with latent tuberculosis infection were: contact with detainee (OR = 2.12, 95%CI 1.21–3.71); male gender (OR = 1.97, 95%CI 1.19–3.27); between 30 and 39 years old (OR = 2.98, 95%CI 1.34–6.63), 40 to 49 years old (OR = 4.32, 95%CI 1.94–9.60), and 50 to 59 years old (OR = 3.98, 95%CI 1.68–9.43); nonwhite color or race (OR = 1.89, 95%CI 1.29–2.78); and smoker (OR = 1.64, 95%CI 1.05–2.55). There were no positive test on sputum smear microscopy and culture. Of the 241 (22.8%) professionals who underwent radiological examination, 48 (19.9%) presented alterations of which 11 were suspected of tuberculosis. CONCLUSIONS Prison employees who have direct contact with detainees are 2.12 times more likely to become infected with Mycobacterium tuberculosis in the work environment and consequently to become ill with tuberculosis and should be targeted for disease prevention and control.

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ABSTRACT OBJECTIVE To assess the quality of the health care provided to children aged under one year old performed by primary health services in the South and Northeast regions of Brazil. METHODS This is a cross-sectional, population-based study carried out in 2010 with 7,915 children aged from one to four years, whose homes are located in the areas of health service coverage. We described the prevalence of procedures and guidelines, such as weight and height measurement, vaccination, newborn blood spot screening, evaluation of umbilical cord, instruction on breastfeeding and introduction of new food, and their respective 95% confidence intervals. The differences were analyzed using the chi-square test of heterogeneity and linear trend. We considered the main outcome of high-quality infant care if the child had received all recommended procedures and guidelines in the first year of life. For this analysis, we used the Poisson regression considering hierarchical model. RESULTS There was low prevalence for the instruction on breastfeeding in the first week of life (58.8%, 95%CI 57.5–60.0) and on the introduction of new food in the fourth month care. The prevalence of high-quality in childcare was 42.0% (95%CI 40.5–43.5). The adjusted analysis according to hierarchical model indicated greater probability of this outcome in the Northeast region (PR = 1.17, 95%CI 1.09–1.26), in smaller municipalities (PR = 1.17, 95%CI 1.03–1.33), and in municipalities with 50,000 and 99,000 inhabitants (PR = 1.20, 95%CI 1.09–1.34). CONCLUSIONS The Northeast region has higher-quality infant care services, which can be explained by the consolidation of the Family Health Strategy in that region.

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ABSTRACT Abnormal general movements are among the most reliable markers for cerebral palsy. General movements are part of the spontaneous motor repertoire and are present from early fetal life until the end of the first half year after term. In addition to its high sensitivity (98%) and specificity (91%), the assessment of general movements is non-invasive and time- and cost-efficient. It is therefore ideal for assessing the integrity of the young nervous system, most notably in lowresource settings. Studies on the general movements assessment in low- and middle-income countries such as China, India, Iran, or South Africa are still rare but increasing. In Brazil, too, researchers have demonstrated that the evaluation of general movements adds to the functional assessment of the young nervous system. Applying general movements assessment in vulnerable populations in Brazil is therefore highly recommended.

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RESUMO OBJETIVO Descrever os eventos adversos pós-vacina ocorridos em crianças com até dois anos de idade e analisar a tendência desses eventos, entre 2000 e 2013, em Araraquara, SP, Brasil. MÉTODOS Estudo descritivo com dados da vigilância passiva de eventos adversos pós-vacina, disponíveis no registro informatizado de imunização do prontuário eletrônico do serviço municipal de saúde (Sistema Juarez). As variáveis de estudo foram: idade, sexo, vacina, dose, manifestações clínicas e hospitalização. As taxas foram estimadas tomando-se os casos de eventos adversos pós-vacina como numerador e as doses aplicadas, como denominador. Estimou-se a sensibilidade da vigilância de eventos adversos pós-vacina aplicando-se o método proposto pelo Centers for Disease Control and Prevention. Para análise de tendência utilizou-se a regressão de Prais-Winsten, considerando o nível de significância de 5,0%. RESULTADOS A taxa anual média de eventos adversos pós-vacina foi de 11,3/10.000 doses aplicadas, porém, sem tendência no período estudado (p = 0,491). Houve predomínio de casos após a primeira dose (41,7%) e entre menores de um ano de idade (72,6%). As vacinas com componente pertussis, de febre amarela e de sarampo-caxumba-rubéola foram as mais reatogênicas. Destacou-se a frequência de episódio hipotônico hiporresponsivo e convulsão, com taxas de 4,1/10.000 e 1,5/10.000 doses de vacinas com componente pertussis, respectivamente, mais elevadas na primeira dose; 60,0% dos casos apresentaram sintomas nas primeiras 24 horas após a vacinação e 18,6% apresentaram-se após 96 horas. A sensibilidade da vigilância foi estimada em 71,9% e 78,9% para episódio hipotônico hiporresponsivo e convulsão, respectivamente. CONCLUSÕES O sistema de vigilância de eventos adversos pós-vacina com base no registro informatizado de imunização mostrou-se útil e dotado de elevada sensibilidade para descrever o perfil de segurança das vacinas em um município de médio porte. Adicionalmente, a expressiva ampliação, na última década, das vacinas incluídas no esquema básico de vacinação na infância não alterou o elevado padrão de segurança do Programa Nacional de Imunizações.

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ABSTRACT OBJECTIVE To describe adverse events following vaccination (AEFV) of children under two years old and analyze trend of this events from 2000 to 2013, in the city of Araraquara (SP), Brazil. METHODS This is a descriptive study conducted with data of the passive surveillance system of AEFV that is available in the electronic immunization registry (EIR) of the computerized medical record of the municipal health service (Juarez System). The study variables were: age, gender, vaccine, dose, clinical manifestations and hospitalization. We estimated rates using AEFV as numerator and administered doses of vaccines as denominator. The surveillance sensitivity was estimated by applying the method proposed by the Centers for Disease Control and Prevention. We used Prais-Winsten regression with a significance level of 5.0%. RESULTS The average annual rate of AEFV was 11.3/10,000 administered doses, however without a trend in the study period (p=0.491). Most cases occurred after the first dose (41.7%) and among children under one year of age (72.6%). Vaccines with pertussis component, yellow fever and measles-mumps-rubella were the most reactogenic. We highlighted the rates of hypotonic-hyporesponsive episodes and convulsion that were 4.1/10,000 and 1.5/10,000 doses of vaccines with pertussis component, respectively, most frequently in the first dose; 60,0% of cases presented symptoms in the first 24 hours after vaccination, however, 18.6% showed after 96 hours. The sensitivity of surveillance was 71.9% and 78.9% for hypotonic-hyporesponsive episodes and convulsion, respectively. CONCLUSIONS The EIR-based AEFV surveillance system proved to be useful and highly sensitive to describe the safety profile of vaccines in a medium-sized city. It was also shown that the significant increase of the vaccines included in the basic vaccination schedule in childhood in the last decade did not alter the high safety standard of the National Immunization Program.

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RESUMO OBJETIVO Analisar a tendência das taxas de mortalidade por câncer de boca e de faringe no período de 2002–2013 no Brasil segundo sexo, sítio anatômico e macrorregião do país. MÉTODOS Os dados sobre mortalidade foram obtidos junto ao Sistema de Informações sobre Mortalidade e os dados das populações foram obtidos junto ao Instituto Brasileiro de Geografia e Estatística. A tendência das taxas padronizadas por sexo e faixa etária foi calculada por regressão de Prais-Winstein, obtendo a sua variação percentual anual e os respectivos intervalos de confiança de 95%, analisados segundo sexo, macrorregião e sítio anatômico. RESULTADOS O coeficiente médio de mortalidade por câncer de boca foi de 1,87/100.000 habitantes e permaneceu estável durante o período estudado. O coeficiente de mortalidade por câncer de faringe foi de 2,04/100.000 habitantes e apresentou variação percentual anual de -2,6%. Aproximadamente oito em cada 10 óbitos ocorreram entre homens. Observou-se aumento nas taxas por câncer de boca na região Nordeste (variação percentual anual de 6,9%) e diminuição na região Sudeste (variação percentual anual -2,9%). Mortalidade por câncer de faringe diminuiu nas regiões Sudeste e Sul com variação percentual anual de -4,8% e -5,1% respectivamente. Mortalidade por câncer de amígdala, outras glândulas salivares maiores, hipofaringe e outras partes não especificas de boca e faringe, apresentaram tendência de declínio enquanto os demais sítios apresentaram estabilidade. CONCLUSÕES A mortalidade por câncer de faringe apresentou diminuição no período 2002–2013. O câncer de boca apresentou aumento só na região Nordeste. Mortalidade por câncer de amígdala, outras glândulas maiores, hipofaringe e outras localizações mal definidas de lábio, cavidade oral e faringe mostraram declínio.

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ABSTRACT OBJECTIVE To analyze the trend of oral and pharyngeal cancer mortality rates in the period of 2002 to 2013 in Brazil according to sex, anatomical site, and macroregion of the country. METHODS The mortality data were obtained from the Mortality Information System and the population data were obtained from the Brazilian Institute of Geography and Statistics. The trend of the rates standardized by sex and age was calculated using the Prais-Winsten estimation, and we obtained the annual percentage change and the respective 95% confidence intervals, analyzed according to sex, macroregion, and anatomical site. RESULTS The average coefficient of oral cancer mortality was 1.87 per 100,000 inhabitants and it remained stable during the study period. The coefficient of pharyngeal cancer mortality was 2.04 per 100,000 inhabitants and it presented an annual percentage change of -2.6%. Approximately eight in every 10 deaths occurred among men. There was an increase in the rates of oral cancer in the Northeast region (annual percentage change of 6.9%) and a decrease in the Southeast region (annual percentage change of -2.9%). Pharyngeal cancer mortality decreased in the Southeast and South regions with annual percentage change of -4.8% and -5.1% respectively. Cancer mortality for tonsil, other major salivary glands, hypopharynx, and other and unspecified parts of mouth and pharynx showed a decreasing trend while the other sites presented stability. CONCLUSIONS Pharyngeal cancer mortality decreased in the period of 2002 to 2013. Oral cancer increased only in the Northeast region. Mortality for tonsil cancer, other major salivary glands, hypopharynx, and other and ill-defined sites in the lip, oral cavity, and pharynx decreased.

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RESUMO OBJETIVO Avaliar a efetividade do programa educativo em diabetes mellitus na atenção primária à saúde. MÉTODOS Este ensaio clínico randomizado por conglomerados foi realizado em amostra de 470 pessoas com diabetes mellitus tipo 2, provenientes de oito unidades de saúde, alocadas aleatoriamente em dois grupos: intervenção (n = 231) e controle (n = 239). O grupo intervenção participou do programa educativo composto de três estratégias: educação em grupo, visita domiciliar e intervenção telefônica. Simultaneamente, o grupo controle foi acompanhado individualmente. O acompanhamento dos grupos ocorreu ao longo de nove meses no ano de 2012. Foram realizadas avaliações clínicas no tempo inicial (T0), três (T3), seis (T6) e nove (T9) meses depois do início da intervenção. RESULTADOS Após nove meses de seguimento, permaneceram no estudo 341 usuários, 171 no grupo controle e 170 no grupo intervenção. A média de idade dos usuários era de 60,6 anos. Em ambos os grupos, observou-se diferenças estatisticamente significativas nos níveis médios de HbA1c ao longo do tempo de acompanhamento (p < 0,05). Porém, o nível médio de HbA1c nos tempos T3, T6 e T9 foi significativamente menor entre as pessoas do grupo intervenção (p < 0,05). CONCLUSÕES O modelo do programa educativo desenvolvido foi efetivo para a melhora do controle glicêmico dos participantes do grupo intervenção.

Resumo em Inglês:

ABSTRACT OBJECTIVE Evaluate the effectiveness of a diabetes mellitus educational program in primary health care. METHODS This cluster randomized trial was conducted in a sample of 470 people with type 2 diabetes mellitus from eight health units, randomly assigned to two groups: intervention (n = 231) and control (n = 239). The intervention group participated in the educational program composed of three strategies: group education, home visit, and telephone intervention. Simultaneously, the control group was monitored individually. Group monitoring took place over nine months in the year 2012. Clinical evaluations were performed at the initial time (T0), three (T3), six (T6) and nine (T9) months after the beginning of the intervention. RESULTS After nine months of follow-up, 341 users remained in the study, 171 in the control group and 170 in the intervention group. The average age of users was 60.6 years. In both groups, statistically significant differences were observed in mean HbA1c levels over the follow-up time (p < 0.05). However, the mean HbA1c level at T3, T6 and T9 times were significantly lower among the people in the intervention group (p < 0.05). CONCLUSIONS The educational program model developed was effective to improve the glycemic control of the intervention group participants.

Resumo em Espanhol:

RESUMEN OBJETIVO Analizar la tendencia de los Indicadores Clave del Sistema Nacional de Salud de España y sus comunidades autónomas, relacionados con la Atención Especializada, desde la publicación de la Ley de Cohesión y Calidad. MÉTODOS Estudio ecológico de series temporales de España y sus comunidades autónomas desde 2003 hasta 2014. Se analizaron 10 indicadores relacionados con Atención Especializada (porcentaje de gasto, profesionales, listas de espera, actividad quirúrgica, estancia media, infecciones y mortalidad) utilizando el método de auto-regresión de Prais-Winsten. Los datos se obtuvieron del sistema de información sanitaria del Ministerio de Sanidad, Servicios Sociales e Igualdad español. RESULTADOS Existió una tendencia creciente del gasto en atención especializada (APC = 0,059; IC95% 0,041–0,074), número de profesionales de medicina (APC = 0,0006; IC95% 0,0003–0,0009) y enfermería (APC = 0,001; IC95% 0,0005–0,0016), infecciones hospitalarias (APC = 0,0003; IC95% 0,0002–0,0004) y mortalidad intrahospitalaria (APC = 0,0008; IC95% 0,0006–0,001) en España. La estancia media presentó una tendencia decreciente (APC = -0,0017; IC95% -0,002– -0,0014). La tendencia de las listas de espera (consulta especializada e intervenciones quirúrgicas no urgentes) fue estática. La tendencia de estos indicadores varió en las Comunidades Autónomas. CONCLUSIONES Se observa un incumplimiento de los principios de equidad y calidad de las prestaciones ofrecidas. El aumento del envejecimiento, el desarrollo tecnológico y estrategias poco adecuadas tomadas para reducir los costes sanitarios pueden ser las principales causas.

Resumo em Inglês:

ABSTRACT OBJECTIVE The objective of this study is to analyze the trend of the Key Indicators of the National Health System of Spain and its autonomous communities, related to Specialized Care, from the publication of the Law of Cohesion and Quality. METHODS This is an ecological study of temporary series of Spain and its autonomous communities from 2003 to 2014. We have analyzed 10 indicators related to Specialized Care (percentage of expenditure, professionals, waiting lists, surgical activity, average duration, infections, and mortality) using the Prais-Winsten regression method. We have obtained data from the health information system of the Spanish Ministry of Health, Social Services, and Equality. RESULTS Specialized care expenditure (APC = 0.059, 95%CI 0.041–0.074), number of medical professionals (APC = 0.0006, 95%CI 0.0003–0.0009) and nursing professionals (APC = 0.001, 95%CI 0.0005–0.0016), hospital infections (APC = 0.0003, 95%CI 0.0002–0.0004), and in-hospital mortality (APC = 0.0008, 95%CI 0.0006–0.001) had an increasing trend in Spain. Average duration presented a decreasing trend (APC = -0.0017, 95%CI -0.002– -0.0014). The trend of waiting lists (specialized appointment and non-urgent surgical interventions) was static. The trend of these indicators varied in the Autonomous Communities. CONCLUSIONS We have observed a non-compliance with the principles of equity and quality of the services offered. Increased aging, technological development, and inadequate strategies taken to reduce health costs may be the main causes.

Resumo em Inglês:

ABSTRACT Chile has lower breast cancer incidence rates compared to those in developed countries. Our public health system aims to perform 10 biennial screening mammograms in the age group of 50 to 69 years by 2020. Using a dynamic programming model, we have found the optimal ages to perform 10 screening mammograms that lead to the lowest lifetime death rate and we have evaluated a set of fixed inter-screening interval policies. The optimal ages for the 10 mammograms are 43, 47, 51, 54, 57, 61, 65, 68, 72, and 76 years, and the most effective fixed inter-screening is every four years after the 40 years. Both policies respectively reduce lifetime death rate in 6.4% and 5.7% and the cost of saving one life in 17% and 9.3% compared to the 2020 Chilean policy. Our findings show that two-year inter-screening interval policies are less effective in countries with lower breast cancer incidence; thus we recommend screening policies with a wider age range and larger inter-screening intervals for Chile.

Resumo em Português:

RESUMO OBJETIVO Analisar se a presença do acompanhante favorece a aplicação das boas práticas na atenção ao parto na região Sul do Brasil. MÉTODOS Análise transversal do estudo longitudinal Nascer no Brasil. Foram analisados dados de 2.070 mulheres da região Sul que entraram em trabalho de parto. Os dados foram coletados entre fevereiro e agosto de 2011, por meio de entrevista e prontuário. Realizou-se análise bivariada e multivariada, calculando-se razões de prevalência brutas e ajustadas por regressão de Poisson com estimação de variância robusta. Adotou-se nível de significância de 5%. RESULTADOS A maioria das mulheres teve o acompanhante durante o trabalho de parto (51,7%), mas poucas permaneceram com ele no parto (39,4%) ou na cesariana (34,8%). Menos da metade das mulheres teve acesso às várias práticas recomendadas, enquanto práticas não recomendadas continuam sendo realizadas. No modelo ajustado por idade, escolaridade, fonte de pagamento do parto, paridade e escore da Associação Brasileira de Institutos de Pesquisa de Mercado, a presença do acompanhante esteve estatisticamente associada à maior oferta de líquidos/alimentos (RPa = 1,34), prescrição de dieta (RPa = 1,34), uso de métodos não farmacológicos para alívio da dor (RPa = 1,37), amniotomia (RPa = 1,10), analgesia peridural ou ráqui (RPa = 1,84), adoção de posição não litotômica no parto (RPa = 1,77), permanência na mesma sala durante o trabalho de parto, parto e pós-parto (RPa = 1,62), contato pele a pele no parto (RPa = 1,81) e na cesariana (RP = 2,43), bem como redução da manobra de Kristeller (RPa = 0,67), tricotomia (RPa = 0,59) e enema (RPa = 0,49). CONCLUSÕES Na região Sul do Brasil, além de sofrer várias intervenções desnecessárias, a maioria das mulheres não têm acesso às boas práticas. A presença do acompanhante está associada a diversas práticas benéficas e à redução de algumas intervenções, embora outras não sofram impacto.

Resumo em Inglês:

ABSTRACT OBJECTIVE To analyze if the presence of a companion favors the use of best practices in the delivery care in the South region of Brazil. METHODS This is a cross-sectional analysis of the longitudinal study Nascer no Brasil. We analyzed data from 2,070 women from the South region of Brazil who went into labor. The data were collected between February and August 2011, by interviews and medical records. We performed a bivariate and multivariate analysis, calculating the crude and adjusted prevalence ratios using Poisson regression with robust variance estimation. The level of significance adopted was 5%. RESULTS Most women had a companion during labor (51.7%), but few remained during delivery (39.4%) or cesarean section (34.8%). Less than half of the women had access to several recommended practices, while non-recommended practices continue to be performed. In the model adjusted for age, education level, source of payment for the delivery, parity, and score of the Brazilian Association of Market Research Institutes, the presence of a companion was statistically associated with a greater supply of liquids and food (aPR = 1.34), dietary prescription (aPR = 1.34), use of non-pharmacological methods for pain relief (aPR = 1.37), amniotomy (aPR = 1.10), epidural or spinal analgesia (aPR = 1.84), adoption of non-lithotomy position in the delivery (aPR = 1.77), stay in the same room during labor, delivery, and postpartum (aPR = 1.62), skin-to-skin contact in the delivery (aPR = 1.81) and cesarean section (PR = 2.43), as well as reduced use of the Kristeller maneuver (aPR = 0.67), trichotomy (aPR = 0.59), and enema (aPR = 0.49). CONCLUSIONS In the South region of Brazil, most women do not have access to the best practices in addition to undergoing several unnecessary interventions. The presence of a companion is associated with several beneficial practices and the reduction in some interventions, although other interventions are not impacted.

Resumo em Português:

RESUMO OBJETIVO Avaliar, após seis meses, a efetividade de uma intervenção digital na diminuição da prática de binge drinking entre frequentadores de baladas. MÉTODOS Foi realizado um inquérito de portal através de uma amostra probabilística em 31 baladas da cidade de São Paulo, a qual originou um ensaio controlado randomizado com 1.057 participantes. Aqueles classificados como uso problemático do álcool (n = 465) através do Alcohol Use Disorders Identification Test foram randomizados em dois grupos de estudo – intervenção e controle. A intervenção digital consistiu em expor os participantes a uma tela de feedback normativo sobre seu consumo de álcool, caracterizando os riscos associados à quantidade consumida, valores gastos com bebidas, beber e dirigir, classificação do risco do Alcohol Use Disorders Identification Test e dicas de redução de danos. RESULTADOS Houve uma redução significativa da prática de binge drinking na semana estimada em 38% entre os participantes do grupo intervenção após seis meses (p < 0,05). Porém, não houve redução significativa nos desfechos quando se analisam os grupos intervenção e controle e os tempos início e seis meses após, simultaneamente. CONCLUSÕES Não se pode concluir que as ferramentas digitais reduzem o padrão de binge drinking nos frequentadores de baladas paulistanas. São necessários mais estudos com esta metodologia devido ao caráter atrativo para esse grupo, tendo em vista a privacidade e a rapidez que as informações personalizadas são transmitidas.

Resumo em Inglês:

ABSTRACT OBJECTIVE To evaluate the effectiveness of a web-based intervention in reducing binge drinking among nightclub patrons after six months. METHODS We carried out a website survey with probabilistic sample in 31 nightclubs in the city of São Paulo, Brazil, which originated a randomized controlled trial with 1,057 participants. Those classified as problem drinkers (n = 465) using the Alcohol Use Disorders Identification Test were randomized into two study groups – intervention and control. The web-based intervention consisted of exposing the participants to a normative feedback screen about their alcohol consumption, characterizing the risks associated with amount consumed, money spent on drinks, drinking and driving, risk classification of Alcohol Use Disorders Identification Test, and tips to reduce damage. RESULTS There was a significant reduction in the practice of binge drinking in the week estimated at 38% among participants in the intervention group after six months (p < 0.05). However, there was no significant reduction in the outcomes when we analyzed the intervention and control groups and at baseline and after sixth months, simultaneously. CONCLUSIONS We cannot conclude that digital tools reduce the pattern of binge drinking among party goers in São Paulo. More studies are needed with this methodology because of its attractiveness to this type of group, given the privacy and speed that personalized information is transmitted.

Resumo em Espanhol:

RESUMEN OBJETIVO Adaptar culturalmente al español y validar el SPICTTM, una herramienta breve y sencilla para apoyar una mejor identificación de pacientes crónicos que presentan necesidades de atención paliativa. MÉTODOS Para este estudio se diseñó un proyecto multicéntrico y nacional entre centros de Galicia, Islas Baleares y Andalucía. Para el proceso de traducción y adaptación transcultural del SPICTTM al castellano, se siguieron los pasos propuestos por Beaton et al. con sucesivas traducciones y posterior consenso de expertos mediante la metodología debriefing. Tras finalizar la validación de contenido se procedió a la validación de las propiedades psicométricas. Se diseñó un estudio longitudinal prospectivo en 188 pacientes de Galicia, Baleares y Andalucía. Fue analizada la consistencia interna y la fiabilidad test-retest a los 10 días por el mismo investigador. RESULTADOS A más del 90% de los participantes SPICT-ESTM les parece sencillo cumplimentarlo, y consideran que está escrito en un lenguaje comprensible. El tiempo medio para aplicar el cuestionario sin conocimiento previo fue de 4 minutos y 45 segundos. Para la evaluación de la consistencia interna del instrumento, se ha utilizado la fórmula Kuder Richardson 20. La consistencia interna es de 0,71. El índice de concordancia del test Kappa se encuentra entre 0,983 y 0,797 para los distintos ítems. CONCLUSIONES En este estudio se ha demostrado la equivalencia de contenido con el original. Además, la validación de las propiedades psicométricas establece que SPICT-ESTM mantiene una adecuada fiabilidad y estabilidad. Si añadimos la satisfacción mostrada por los profesionales y la facilidad de uso, SPICT-ESTM es una herramienta adecuada para la identificación de pacientes paliativos con enfermedades crónicas y necesidad de cuidados paliativos.

Resumo em Inglês:

ABSTRACT OBJECTIVE To culturally adapt and validate the SPICTTM to Spanish, which is a brief and simple tool to support a better identification of chronic patients who have palliative care needs. METHODS For this study, we designed a multicenter and national project between the centers of Galicia, Balearic Islands, and Andalusia. For the process of translation and cross-cultural adaptation of the SPICTTM to Spanish, we followed the steps proposed by Beaton et al. with successive translations and subsequent consensus of experts using the debriefing methodology. After the content validation was completed, the psychometric properties were validated. A prospective longitudinal study was designed with 188 patients from Galicia, the Balearic Islands, and Andalusia. The internal consistency and reliability of the test and retest was analyzed for 10 days by the same researcher. RESULTS For more than 90% of the participants of the SPICT-ESTM, it seems simple to be filled out, and they consider it written in an understandable language. The average time to apply the questionnaire without prior knowledge was 4 minutes and 45 seconds. To evaluate the internal consistency of the instrument, we used the Kuder-Richardson formula 20. Internal consistency is 0.71. The agreement index of the Kappa test is between 0.983 and 0.797 for the different items. CONCLUSIONS In this study, we demonstrate the equivalence of content with the original. In addition, the validation of the psychometric properties establishes that the SPICT-ESTM maintains adequate reliability and stability. If we add the satisfaction shown by the professionals and the ease of use, the SPICT-ESTM is an adequate tool for the identification of palliative patients with chronic diseases and palliative care needs.