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Revista de Saúde Pública, Volume: 55, Published: 2021
  • National Food Surveys: diet and more Editorial

    Domene, Semíramis Martins Alves; Barata, Rita Barradas
  • Factors associated with musculoskeletal symptoms in professionals working in sitting position Original Article

    Lopes, Anália Rosário; Trelha, Celita Salmaso; Robazzi, Maria Lúcia do Carmo Cruz; Reis, Roberta Alvarenga; Pereira, Maria José Bistafa; Santos, Claudia Benedita dos

    Abstract in Portuguese:

    RESUMO OBJETIVOS Estimar a prevalência de sintomas osteomusculares e analisar os fatores a eles associados em profissionais de setores administrativos que trabalham predominantemente na postura sentada. MÉTODOS Trata-se de estudo transversal com dados obtidos de 451 trabalhadores de instituição pública federal na região Sul do país. A variável dependente foi o número de sintomas osteomusculares nos últimos 12 meses, aferido utilizando-se o Questionário Nórdico de Sintomas Osteomusculares. Foram investigadas 19 variáveis independentes, divididas em quatro categorias: características sociodemográficas, comportamentais, ocupacionais e de saúde. Foi realizada análise univariada e, na sequência, regressão múltipla de Poisson com variância robusta. As variáveis independentes foram inseridas em blocos com critério backward stepwise, considerando o valor para estatística de Wald igual a 0,20. As medidas de efeito foram expressas em aumento relativo (AR) no valor médio, sendo os dados analisados para um nível de significância de 5%. RESULTADOS A prevalência estimada de sintomas osteomusculares nos últimos 12 meses foi de 90% (intervalo de confiança – IC95% 87–93). No modelo final da análise de regressão, as variáveis sexo feminino (AR = 14,75%), índice de capacidade para o trabalho baixo (AR = 100,02%) e moderado (AR = 64,06%), uso de medicamentos (AR = 48,06%) e circunferência da cintura em risco (AR = 15,59%) tiveram associação significativa com o aumento da média de sintomas; já a escolaridade com ensino técnico atuou como fator de proteção, reduzindo a média em 36,46%. CONCLUSÕES A alta prevalência de sintomas osteomusculares encontrada e os fatores associados indicam a necessidade de propor ações e cuidados específicos para essa população, como tratamento imediato dos sintomas e mudanças na organização e no ambiente laboral, a fim de alcançar equilíbrio e harmonia nas exigências do trabalho sentado prolongado e evitar o impacto dessa condição na saúde pública.

    Abstract in English:

    ABSTRACT OBJECTIVE To estimate the prevalence of musculoskeletal symptoms and analyze their associated factors in professionals from administrative sectors working predominantly in sitting position. METHODS This is a cross-sectional study with data obtained from 451 workers from a federal public institution in Southern Brazil. The dependent variable was the number of musculoskeletal symptoms in the prior 12 months, measured using the Nordic Musculoskeletal Questionnaire. In the analyses, 19 independent variables were investigated, divided into four categories: sociodemographic, behavioral, occupational and health characteristics. Univariate analysis and multiple Poisson regression with robust variance were performed. The independent variables were inserted into blocks with stepwise backward criterion, considering the value for Wald statistics equal to 0.20. The effect measures were expressed in a relative increase (RI) in the mean value, and the data were analyzed for a 5% significance level. RESULTS The estimated prevalence of musculoskeletal symptoms in the prior 12 months was 90% (confidence interval – 95%CI 87–93). In the final model of regression analysis, the variables female gender (RI = 14.75%), low (RI = 100.02%) and moderate (RI = 64.06%) work ability index, use of medications (RI = 48.06%) and waist circumference at risk (RI = 15.59%) had a significant association with the increase in the mean number of symptoms; schooling with technical education acted as a protective factor, reducing the mean by 36.46%. CONCLUSIONS The high prevalence of musculoskeletal symptoms found and the associated factors indicate the need to propose specific actions and care for this population, such as immediate treatment of symptoms and changes in the organization and work environment, to achieve balance and harmony in the demands of prolonged sitting work and avoid its impact effect of this condition on public health.
  • Smoking prevalence and economic crisis in Brazil Original Article

    Souza, Luis Eugenio de; Rasella, Davide; Barros, Rafael; Lisboa, Erick; Malta, Déborah; Mckee, Martin

    Abstract in English:

    ABSTRACT OBJECTIVE To estimate the impact of the 2015–2018 economic crisis on tobacco consumption in Brazil. METHODS This is an interrupted time series analysis conducted with data from 27 cities collected by VIGITEL, using linear regression models to account for first-order autocorrelation. Analyses were conducted based on gender, age group, and education level. RESULTS Smoking rates decreased between 2006 and 2018, decelerating after the crisis onset. Differently than women, men showed an immediate but transient increase in smoking, followed by a decelerated decrease. Those over 65 also showed increased smoking rates immediately after the economic crisis onset, but decline accelerated later on. In turn, we found a trend reversal among those aged 31–44. Rates also decreased among those with lower education levels, but decelerated among those with more years of schooling. CONCLUSION An economic crisis have varied impacts on the smoking habits of different population groups. Tobacco control policies should entail a detailed understanding of smoking epidemiology, especially during an economic crisis.
  • Factors associated with stress, anxiety, and depression during social distancing in Brazil Original Article

    Souza, Alex Sandro Rolland; Souza, Gustavo Fonseca Albuquerque; Souza, Gabriela Albuquerque; Cordeiro, Ana Lorena Nascimento; Praciano, Gabriella Almeida Figueredo; Alves, Adricia Cristine de Souza; Santos, Alan Chaves dos; Silva Junior, José Roberto; Souza, Manuela Barbosa Rodrigues

    Abstract in English:

    ABSTRACT OBJECTIVE To estimate the prevalence of clinical signs and symptoms of severe/extreme stress, anxiety, and depression, as well as their associated factors, among Brazilians during social distancing. METHODS This is a cross-sectional study conducted in April/May 2020 with 3,200 Brazilians over 18 years old. Respondents’ sociodemographic and clinical data were collected using an online questionnaire, which also included the 21-item Depression, Anxiety and Stress Scale (DASS-21) to assess emotional symptoms. Unadjusted and adjusted prevalence ratios and their respective 95% confidence intervals were estimated using Poisson regression models with robust variance. RESULTS Our results show the prevalence of severe/extreme stress was 21.5%, anxiety 19.4%, and depression 21.5%. In the final model, sociodemographic, clinical, and Covid-19-related factors were associated with severe/extreme stress, anxiety, and depression in Brazilians during social distancing due to the Covid-19 pandemic. We found the main factors associated with severe/extreme depression to be young women, brown, single, not religious, sedentary, presenting reduced leisure activities, history of anxiety and depression, increased medication use, and Covid-19 symptoms. CONCLUSION This study may help develop and systematically plan measures aimed to prevent, early identify, and properly manage clinical signs and symptoms of stress, anxiety, and depression during the Covid-19 pandemic.
  • Prelabor cesarean section: the role of advanced maternal age and associated factors Original Article

    Martinelli, Katrini Guidolini; Gama, Silvana Granado Nogueira da; Almeida, André Henrique do Vale de; Nakamura-Pereira, Marcos; Santos Neto, Edson Theodoro dos

    Abstract in English:

    ABSTRACT OBJECTIVE to evaluate whether advanced maternal age (AMA) is associated with prelabor cesarean section and to identify the factors associated with prelabor cesarean section in AMA women, according to the mode of type of labor financing (private or public). METHODS Based on the Birth in Brazil survey, the research was conducted on representative sample of mothers for the country (Brazil), regions, type of hospital and location (capital or not), in 2011/2012. This study included 15,071 women from two age groups: 20–29 years and ≥ 35 years. The information was collected from interviews with puerperal woman, prenatal cards, and medical records of mothers and newborns. Multiple logistic regression modelling was used to verify the association between prelabor cesarean section and maternal, prenatal and childbirth characteristics, according to the mode of financing. RESULTS Our results showed a higher use of prelabor cesarean section for AMA (≥ 35 years) women in the public service (OR = 1.63; 95%CI 1.38–1.94) and in the private service (OR = 1.44; 95%CI 1.13–1.83), compared with women aged 20–29 years. In the adjusted model, we recorded three factors associated with the prelabor cesarean section in AMA women in both, public and private sectors: the same professional in prenatal care and childbirth (OR = 4.97 and OR = 4.66); nulliparity (OR = 6.17 and OR = 10.08), and multiparity with previous cesarean section (from OR = 5.73 to OR = 32.29). The presence of obstetric risk (OR = 1.94; 95%CI .44–2.62) also contributed to the occurrence of prelabor cesarean section in women who gave birth in the public service. CONCLUSIONS AMA was an independent risk factor for prelabor cesarean in public and private services. In the public, prelabor cesarean in AMA was more influenced by clinical criteria. Higher chance of prelabor cesarean section in nulliparous women increases the chance of cesarean section in multiparous women, as we showed in this study, which increases the risk of anomalous placental implantation.
  • Impact of matrix support on older adults in primary care: randomized community trial Original Article

    Maia, Luciana Colares; Colares, Thomaz de Figueiredo Braga; Morais, Edgar Nunes de; Costa, Simone de Melo; Caldeira, Antônio Prates

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar o impacto do apoio matricial em saúde ao idoso na atenção primária de acordo com as dimensões de fragilidade aferidas por meio do índice de vulnerabilidade clínico-funcional (IVCF-20). MÉTODOS Trata-se de ensaio comunitário randomizado controlado (ECRC), desenvolvido no norte de Minas Gerais, Brasil, em 2018. Inicialmente ocorreu, por meio do IVCF-20, a estratificação de vulnerabilidade clínico-funcional dos idosos assistidos por seis equipes de Estratégia de Saúde da Família. Posteriormente, três equipes foram sorteadas para receber apoio matricial durante seis meses, e as demais, para controle. Nesta intervenção, desenvolveram-se atividades educativas presenciais para as equipes de saúde. Realizou-se estatística descritiva, seguida de análise bivariada pelo teste qui-quadrado de Pearson, para comparação das variáveis do IVCF-20 entre os dois momentos (antes e após a intervenção), com nível de significância de 5%. Estimaram-se os riscos relativos (RR) e os respectivos intervalos de confiança de 95% (IC95%). RESULTADOS Os grupos eram similares antes da intervenção, e o efeito de ações de matriciamento foi positivo para a maioria das dimensões aferidas pelo IVCF-20 (atividade de vida diária instrumental, cognição, humor, mobilidade, comunicação e comorbidades múltiplas). O percentual de fragilidade no grupo assistido por profissionais participantes do apoio matricial, ao final da pesquisa, foi inferior ao do grupo controle. CONCLUSÕES As ações de matriciamento, como atribuição pedagógica e assistência horizontal para as equipes de saúde, têm o potencial de contribuir para a articulação de modelos de cuidado para a saúde do idoso. REBEC registro BR-7b9xff

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze the effect of matrix support on health for older adults in primary care according to the dimensions of frailty measured with the Clinical-Functional Vulnerability Index-20 (IVCF-20). METHODS This is a randomized controlled community trial, developed in the Northern Minas Gerais state, Brazil, in 2018. Initially, the stratification of clinical and functional vulnerability of older adults supported by six Family Health Strategy teams occurred with the IVCF-20. Subsequently, three teams were drawn to receive matrix support for six months, and the others for control. In this intervention, face-to-face educational activities were developed for health teams. Descriptive statistics were performed, followed by bivariate analysis by Pearson’s chi-square test, to compare the variables of the IVCF-20 between the two moments (before and after the intervention), with a 5% significance level. Relative risks and respective 95% confidence intervals (95%CI) were estimated. RESULTS The groups were similar before intervention, and the effect of matrix actions was positive for most dimensions measured by IVCF-20 (instrumental daily living activity, cognition, mood, mobility, communication, and multiple comorbidities). At the end of the research, the percentage of frailty in the group assisted by professionals participating in matrix support was lower than that of the control group. CONCLUSIONS Matrix support actions, such as pedagogical attribution and horizontal care for health teams, have the potential to contribute to the articulation of models of care for older adults. REBEC registro BR-7b9xff
  • Evolution of energy and nutrient intake in Brazil between 2008–2009 and 2017–2018 Original Article

    Verly Junior, Eliseu; Marchioni, Dirce Maria; Araujo, Marina Campos; Carli, Eduardo De; Oliveira, Dayan Carvalho Ramos Salles de; Yokoo, Edna Massae; Sichieri, Rosely; Pereira, Rosangela Alves

    Abstract in Portuguese:

    RESUMO OBJETIVO: Avaliar a evolução da ingestão de energia e nutrientes e a prevalência de inadequação da ingestão de micronutrientes segundo características sociodemográficas e regiões brasileiras. MÉTODOS: Foi analisado o consumo alimentar de 32.749 indivíduos do Inquérito Nacional de Alimentação da Pesquisa de Orçamentos Familiares de 2008–2009, por dois registros alimentares, e de 44.744 indivíduos a partir de dois recordatórios de 24 horas em 2017–2018. Estimaram-se a ingestão usual e o percentual de indivíduos com consumo abaixo da necessidade média para cálcio, magnésio, fósforo, cobre e zinco, vitaminas A, C, D, E, tiamina, riboflavina, piridoxina e cobalamina. A ingestão de sódio foi comparada ao valor de referência para reduzir risco de doenças crônicas. As análises foram estratificadas por sexo, faixa etária, região e renda. RESULTADOS: A ingestão energética diária média foi de 1.753 kcal em 2008–2009 e 1.748 kcal em 2017–2018. As prevalências de inadequação mais elevadas (> 50%) nos dois períodos foram de cálcio, magnésio, vitaminas A, D e E, piridoxina e, somente entre adolescentes, fósforo. Houve aumento na prevalência de inadequação de vitamina A, riboflavina, cobalamina, magnésio e zinco entre as mulheres, e de riboflavina entre os homens. A prevalência de inadequação diminuiu para a tiamina. A ingestão de sódio foi excessiva em aproximadamente 50% da população nos dois períodos. As variações mais altas (cerca de 50%) nas prevalências de inadequação entre os extremos de renda (< 0,5 salário-mínimo e > 2 salários-mínimos per capita) foram observadas para vitamina B12 e C nos dois períodos. As regiões Norte e Nordeste apresentaram maiores prevalências de inadequação. CONCLUSÃO: Ambos os inquéritos verificaram prevalências elevadas de inadequação de ingestão de nutrientes e consumo excessivo de sódio. A inadequação varia de acordo com os estratos de renda, aumentando nas regiões mais pobres do país.

    Abstract in English:

    ABSTRACT OBJECTIVE: To assess the evolution of energy and nutrient intake and the prevalence of inadequate micronutrients intakes according to sociodemographic characteristics and Brazilian regions. METHODS: The food consumption of 32,749 individuals from the National Dietary Survey of the Household Budget Survey 2008–2009 was analyzed by two food registries, as well as 44,744 subjects from two 24-hour recalls in 2017–2018. Usual intake and percentage of individuals with consumption below the average recommendation for calcium, magnesium, phosphorus, copper and zinc, vitamins A, C, D, E, thiamine, riboflavin, pyridoxine and cobalamin were estimated. Sodium intake was compared to the reference value to reduce the risk of chronic diseases. Analyses were stratified by sex, age group, region and income. RESULTS: Mean daily energy intake was 1,753 kcal in 2008–2009 and 1,748 kcal in 2017–2018. The highest prevalence of inadequacy (> 50%) in the two periods were calcium; magnesium; vitamins A, D and E; pyridoxine and, only among adolescents, phosphorus. There was an increase in the prevalence of inadequate vitamin A, riboflavin, cobalamin, magnesium, and zinc among women, and riboflavin among men. The prevalence of inadequacy decreased for thiamine. Sodium intake was excessive in approximately 50% of the population in both periods. The highest variations (about 50%) in the prevalence of inadequacy between the lowest and highest income (< 0.5 minimum wage and > 2 minimum wages per capita) were observed for vitamin B12 and C in both periods. The North and Northeast regions had the highest prevalence of inadequacy. CONCLUSION: Both surveys found high prevalence of inadequate nutrient intake and excessive sodium intake. The inadequacy varies according to income strata, increasing in the poorest regions of the country.
  • Nova score for the consumption of ultra-processed foods: description and performance evaluation in Brazil Original Article

    Costa, Caroline dos Santos; Faria, Franciane Rocha de; Gabe, Kamila Tiemann; Sattamini, Isabela Fleury; Khandpur, Neha; Leite, Fernanda Helena Marrocos; Steele, Eurídice Martínez; Louzada, Maria Laura da Costa; Levy, Renata Bertazzi; Monteiro, Carlos Augusto

    Abstract in Portuguese:

    RESUMO OBJETIVO Descrever o escore Nova de consumo de alimentos ultraprocessados e avaliar seu potencial para refletir, no contexto brasileiro, a participação desses alimentos na dieta. MÉTODOS Estudo realizado na cidade de São Paulo com amostra de conveniência de 300 adultos, que responderam, em cerca de três minutos, em um tablet, a um questionário eletrônico de autorrelato sobre o consumo, no dia anterior, de 23 subgrupos de alimentos ultraprocessados comumente consumidos no Brasil. O escore de cada participante correspondeu ao número de subgrupos reportados. A participação de alimentos ultraprocessados no consumo alimentar do mesmo dia, expressa como percentual da ingestão total de energia, foi calculada por meio das respostas dos participantes a recordatório alimentar completo de 24 horas aplicado em cerca de 30 minutos por nutricionistas treinados. A associação entre o escore e a participação de ultraprocessados na dieta foi estudada por modelos de regressão linear. A concordância na classificação dos participantes segundo quintos do escore e quintos da participação de alimentos ultraprocessados na dieta foi avaliada pelo índice Pabak. RESULTADOS O percentual médio de participação de alimentos ultraprocessados na dieta aumentou linear e significativamente com o aumento do escore Nova de consumo de alimentos ultraprocessados. Observou-se concordância substancial na classificação dos participantes segundo quintos da distribuição do escore e quintos da distribuição do percentual de participação de alimentos ultraprocessados na dieta (índice Pabak = 0,67). Relação inversa da idade com a frequência de consumo relativamente elevado de alimentos ultraprocessados (quinto superior da distribuição) foi observada tanto para o escore quanto para a participação de alimentos ultraprocessados na dieta. CONCLUSÃO O escore Nova de consumo de alimentos ultraprocessados, obtido de forma rápida e prática, apresenta bom potencial para refletir, no contexto brasileiro, a participação desses alimentos na dieta.

    Abstract in English:

    ABSTRACT OBJECTIVE To describe the Nova score for the consumption of ultra-processed foods (UPF) and evaluate its potential in reflecting the dietary share of UPF in Brazil. METHODS This study was conducted in São Paulo with a convenience sample of 300 adults. Using a tablet, participants answered a 3-minute electronic self-report questionnaire on the consumption of 23 subgroups of UPF commonly consumed in Brazil, regarding the day prior the survey. Each participant score corresponded to the number of subgroups reported. The dietary share of UPF on the day prior to the survey, expressed as a percentage of total energy intake, was calculated based on data collected on a 30-minute complete 24-hour dietary recall administered by trained nutritionists. The association between the score and the dietary share of UPF was evaluated using linear regression models. The Pabak index was used to assess the agreement in participants’ classification according to the fifths of Nova score and the fifths of dietary share of UPF. RESULTS The average dietary share of UPF increased linearly and significantly with the increase of the Nova score for the consumption of ultra-processed foods. We found a substantial agreement in participants’ classification according to the fifths of the distribution of scores and the fifths of the dietary share of UPF (Pabak index = 0.67). Age was inversely associated with a relatively high frequency of UPF consumption (upper fifth of the distribution) for both score and dietary share of UPF. CONCLUSION The Nova score for the consumption of ultra-processed foods, obtained in a quick and practical manner, shows a good potential in reflecting the dietary share of UPF in Brazil.
  • Psychiatric hospitalizations by the Unified Health System in Brazil between 2000 and 2014 Original Article

    Rocha, Hugo André da; Reis, Ilka Afonso; Santos, Marcos Antônio da Cunha; Melo, Ana Paula Souto; Cherchiglia, Mariangela Leal

    Abstract in Portuguese:

    RESUMO OBJETIVO Caracterizar o perfil dos pacientes que foram internados por transtornos mentais e comportamentais pelo Sistema Único de Saúde (SUS) no Brasil entre 2000 e 2014, bem como verificar como aspectos da nova política de saúde mental influenciaram a taxa de pacientes internados no referido período. MÉTODOS Estudo de coorte prospectiva não concorrente utilizando dados secundários de pacientes internados com diagnóstico primário de transtornos mentais e comportamentais entre 01/01/2000 e 31/12/2014. Foram selecionadas variáveis sociodemográficas, clínicas e de características do hospital, além disso, foram calculadas as taxas gerais de pacientes internados segundo motivo de internação, tipo de hospital, natureza jurídica e número de internações de cada paciente por ano. Foi testada a associação entre taxas de pacientes internados, número de leitos psiquiátricos por ano e número de Centros de Atenção Psicossocial por ano. RESULTADOS Foram selecionados 1.549.298 pacientes dos quais os diagnósticos mais frequentes na primeira internação foram os transtornos devidos ao uso de substâncias psicoativas, seguidos por esquizofrenia e transtornos de humor. A mediana de internações por paciente foi de 1,9 e a de tempo de internação por paciente foi de 29 dias. A taxa geral de pacientes internados foi reduzida à quase metade no período. O número de leitos por ano apresentou associação positiva com as taxas de pacientes internados, e o número de CAPS por ano teve associação negativa com algumas taxas de pacientes internados. CONCLUSÃO Verificou-se que, mesmo diante de um contexto de adversidades, a Política Nacional de Saúde Mental avançou em suas metas de reduzir progressivamente os leitos hospitalares e aumentar a oferta de serviços substitutivos de tal modo que ambas as estratégias foram associadas à redução das taxas de pacientes internados. Contudo, as mudanças foram percebidas com maior intensidade nos primeiros anos de implantação da política, tornando-se menos pujante nos últimos anos.

    Abstract in English:

    ABSTRACT OBJECTIVE To characterize the profile of patients hospitalized for mental and behavioral disorders by the Unified Health System (SUS) in Brazil between 2000 and 2014, and to verify how aspects of the new mental health policy influenced the rate of hospitalized patients in that period. METHODS Non-concurrent prospective cohort study using secondary data from inpatients with a primary diagnosis of mental and behavioral disorders between 01/01/2000 and 12/31/2014. Sociodemographic, clinical, and hospital characteristics variables were selected. Overall rates of hospitalized patients were calculated according to reason for admission, type of hospital, legal nature, and number of admissions per year for each patient. The association between rates of hospitalized patients, number of psychiatric beds per year, and number of Psychosocial Care Centers per year were tested. RESULTS We selected a total of 1,549,298 patients, whose most frequent diagnoses on first admission were psychoactive substance use disorders, followed by schizophrenia and mood disorders. The median of hospitalizations per patient was 1.9 and the length of stay per patient was 29 days. The overall rate of hospitalized patients was reduced by almost half in the period. The number of beds per year was positively associated with the rates of hospitalized patients; the number of CAPS per year was negatively associated with some rates of hospitalized patients. CONCLUSION Even in the face of adversity, the National Mental Health Policy has advanced in its goal of progressively reducing hospital beds and increasing the supply of substitute services such that both strategies were associated with the reduced inpatient rates. But the changes were felt with greater intensity in the first years of the policy’s implementation, becoming less pronounced in recent years.
  • Embedded implementation research determinants in Latin American health systems Original Article

    García-Cerde, Rodrigo; Becerril-Montekio, Victor; Langlois, Étienne; Reveiz, Ludovic; Alcalde-Rabanal, Jacqueline; Torres-Pereda, Pilar

    Abstract in English:

    ABSTRACT OBJECTIVE: To assess the determinants of embedded implementation research (EIR) conduct in seven Latin American and Caribbean countries. METHODS: This qualitative interpretative study conducted and analyzed 14 semi-structured interviews based on a grounded theory approach using Atlas-ti© 7.5.7. We grouped the conditions appointed by interviewees as determinants of EIR conduct into six domains. RESULTS: The participation of high-level engaged decision makers as research co-producers is an important EIR determinant that fosters research use. Nevertheless, EIR faces challenges such as dealing with key personnel changes and fluctuating political contexts. CONCLUSIONS: Despite its limitations, EIR is effective in creating a sense of ownership of research results among implementers, which helps bridge the gap between research and decision-making in health systems.
  • Climate change and environmental health in undergraduate health degrees in Latin America Original Article

    Palmeiro-Silva, Yasna K; Ferrada, María Teresa; Flores, Jorge Ramírez; Cruz, Ignacio Silva Santa

    Abstract in Spanish:

    RESUMEN OBJETIVO: Analizar la incorporación de cursos de cambio climático y salud ambiental en las mallas curriculares del grado en Medicina, Enfermería, Nutrición y Psicología clínica en universidades latinoamericanas. MÉTODOS: Revisión documental de tipo descriptiva y transversal. Se analizaron las mallas curriculares de las diez primeras universidades latinoamericanas según los rankings QS Latin American University 2020, Times Higher Education World University 2020 y Academic Ranking of World Universities 2019. En cada malla curricular se buscó la presencia de cursos relacionados al cambio climático y la salud ambiental. RESULTADOS: De las 161 universidades que se incluyeron en el estudio, 104 ofrecían la carrera de Medicina, 93 de Enfermería, 77 de Nutrición y 118 de Psicología clínica. La mayor parte de las mallas curriculares incorporaron cursos de salud pública y/o epidemiología (más del 70%), sin embargo, entre el 22% y el 41% incluyeron cursos de salud ambiental, y solo una malla curricular tuvo un curso en cambio climático en Medicina y Enfermería (1%). CONCLUSIONES: Los cursos de cambio climático y salud ambiental han sido introducidos, de forma escasa, en las mallas curriculares del campo de la salud en universidades latinoamericanas. Esto podría debilitar el importante rol que cumplen los profesionales de la salud en la asistencia sanitaria a la población.

    Abstract in English:

    ABSTRACT OBJECTIVE: Analyze the incorporation of climate change and environmental health courses in the curriculum grids of Medicine, Nursing, Nutrition and Clinical Psychology undergraduate courses in Latin American universities. METHODS: Descriptive and cross-sectional document review. Curriculum grids of the top ten Latin American universities were analyzed according to the rankings of QS Latin American University 2020, Times Higher Education World University 2020 and Academic Ranking of World Universities 2019. The presence of courses related to climate change and environmental health was sought in each curriculum grid. RESULTS: 104 of the 161 universities included in the study offered Medicine courses, 93 Nursing courses, 77 Nutrition courses and 118 Clinical Psychology courses. Most of the curriculum grids incorporated courses in public health and/or epidemiology (more than 70%); however, between 22% and 41% included courses on environmental health, and only one curriculum grid had a course on climate change in Medicine and Nursing (1%). CONCLUSIONS: Courses on climate change and environmental health have been scarcely introduced in the curriculum grids of the health field in Latin American universities. This could weaken the important role that health professionals play in providing health care to the population.
  • Locomotor activity in Aedes aegypti with different insecticide resistance profiles Original Article

    Nakazato, Bruno Magalhães; Macoris, Maria de Lourdes da Graça; Urbinatti, Paulo Roberto; Lima-Camara, Tamara Nunes

    Abstract in English:

    ABSTRACT OBJECTIVE: To evaluate locomotor activity in four field populations of Ae. aegypti with different insecticide resistance profiles from the state of São Paulo for two years. METHODS: This study comprised the susceptible Rockefeller strain and four populations from São Paulo, Brazil: two considered populations with “reduced susceptibility” to pyrethroids (Campinas and Marília), and two “resistant populations” (Santos and Ribeirão Preto). First, 2016 and 2017 eggs from these five populations were hatched in laboratory. Virgin females underwent experiments under laboratory conditions at 25°C, with 12:12h light/dark (LD) photoperiod; 24-hour individual activity was recorded using a locomotor activity monitor (LAM). RESULTS: In females from 2016 field populations, both resistant populations showed significant more locomotor activity than the two reduced susceptibility populations and the Rockefeller strain (p < 0.05). As for females from 2017 field populations, reduced susceptibility populations showed a significant increased locomotor activity than the Rockefeller strain, but no significant difference when compared to Santos resistant population (p > 0.05). CONCLUSIONS: Our results indicate that insecticide-resistant Ae. aegypti populations show increased locomotor activity, which may affect the transmission dynamics of their arboviruses.
  • Prevalence and factors associated with covid-19 vaccine hesitancy in Maranhão, Brazil Original Article

    Oliveira, Bruno Luciano Carneiro Alves de; Campos, Marcos Adriano Garcia; Queiroz, Rejane Christine de Sousa; Alves, Maria Teresa Seabra Soares de Britto e; Souza, Bruno Feres de; Santos, Alcione Miranda dos; Silva, Antônio Augusto Moura da

    Abstract in Portuguese:

    RESUMO OBJETIVOS: Estimar a prevalência e fatores associados à hesitação ao uso da vacina contra o vírus SARS-CoV-2 no Maranhão, Brasil. MÉTODOS: Estudo transversal de base populacional realizado de 19 a 30 de outubro de 2020. As estimativas consideraram agrupamento, estratificação e não resposta. A seleção da amostra foi realizada em três estágios (estrato, setores censitários e domicílio). Após análise sistemática, em cada estrato foram selecionados trinta setores, totalizando 150 setores, sendo o número de domicílios em cada setor fixado em 34, totalizando 5.100 domicílios e um indivíduo por domicílio (residente pelo menos há seis meses e com um ano de idade ou mais) selecionado por amostra aleatória simples. A intenção de ser vacinado foi questionada aos participantes. Foi realizada análise descritiva (frequências ponderadas) e teste do qui-quadrado de Pearson para verificar associação univariada entre as variáveis independentes e o desfecho (p < 0,05). Realizou-se análise multivariada robusta utilizando-se modelagem hierarquizada em três níveis. RESULTADOS: Foram entrevistados 4.630 indivíduos. A prevalência de hesitação vacinal foi de 17,5% (IC95% 16,1–19,1%). Após ajuste final do modelo, a hesitação vacinal foi estatisticamente maior entre moradores das cidades de Imperatriz (24,0%; RP = 1,48; IC95% 1,09–2,02) e de munícipios da Grande Ilha de São Luís (20,7%; RP = 1,34; IC95% 1,02–1,76), pessoas do sexo feminino (19,8%; RP = 1,44; IC95% 1,20–1,75), idosos (22,8%; RP = 1,79; IC95% 1,30–2,46), pertencentes às religiões de denominação evangélica (24,1%; RP = 1,49; IC95% 1,24–1,79) e entre aqueles sem relato de sintomas (18,6%; RP = 1,24; IC95% 1,02–1,51). Outras características socioeconômicas e demográficas, assim como variáveis relacionadas ao mercado de trabalho, comportamentos e condições de saúde dos entrevistados, não tiveram diferença estatística. CONCLUSÃO: A prevalência de hesitação vacinal no Maranhão e sua associação com fatores individuais, contextuais e clínicos revelam os grupos e contextos mais resistentes e que devem merecer atenção especial das estratégias públicas para garantir a ampla vacinação.

    Abstract in English:

    ABSTRACT OBJECTIVES: To estimate the prevalence and factors associated with hesitancy in getting the vaccine against SARS-CoV-2 in Maranhão, Brazil. METHODS: This is a cross-sectional population-based study conducted from October 19 to 30, 2020. The estimates were calculated based on clustering, stratification, and non-response. A three-stage sampling was adopted, considering stratum, census tracts, and domicile. After systematic analysis, thirty sectors were selected in each stratum, totaling 150 sectors. Each sector contained a fixed number of 34 households, thus totaling 5,100 households. One individual within each household (resident for at least six months and aged one year or more) was selected by a simple random sampling. We questioned participants about their vaccination intention. Univariate association between independent variables and the outcome were verified using descriptive analysis (weighted frequencies) and Pearson's chi-square test (p < 0.05). Robust multivariate analysis was performed using a three-level hierarchical model. RESULTS: We found 17.5% (95%CI 16.1–19.1%) of the 4,630 individuals interviewed to report hesitancy to be vaccinated against covid-19. After final model adjustment, vaccination hesitancy was statistically higher among residents of the cities of Imperatriz (24.0%; RP = 1.48; IC95% 1.09–2.02) and municipalities of the Grande Ilha de São Luís (20.7%; RP = 1.34; 95%CI 1.02–1.76), female individuals (19.8%; RP = 1.44; 95%CI 1.20–1.75), older adults (22.8%; RP = 1.79; IC95% 1.30–2.46), evangelicals (24.1%; RP = 1.49; 95%CI 1.24–1.79), and those without reported symptoms (18.6%; RP = 1.24; 95%CI 1.02–1.51). We found no statistical differences for other socioeconomic and demographic characteristics, as well as variables related to the labor market, behaviors, and health conditions of the interviewees. CONCLUSION: The prevalence of vaccine hesitancy in Maranhão and its association with individual, contextual, and clinical factors enable us to identify the groups and contexts of greatest resistance, requiring special attention from public strategies to ensure wide vaccination.
  • Breast imaging hindered during covid-19 pandemic, in Brazil Original Article

    Bessa, Jordana de Faria

    Abstract in English:

    ABSTRACT OBJECTIVE: To report the decrease in breast imaging after covid-19 pandemic, obtaining the number of mammograms performed in 2019 and 2020. Additionally, to investigate if there was an increase in the proportion of women undergoing mammography for diagnostic purposes, with palpable lesions. METHOD: This is a cross-sectional study, based on the number of mammograms performed by the Brazilian public health services, provided by DATASUS, an open access database. Mammograms from private institutions were not included. This study compares the number of mammograms performed in 2019 and 2020, in women aged 50–69 years, stratified by month, in each federal state, and the presence of palpable lumps (physician-reported). RESULTS: In total, 1,948,471 mammograms were performed in 2019 and 1,126,688 in 2020, for the population studied. These values represent a 42% decline. Monthly, a significant decreased is observed after April 2020. The results varied slightly according to federal state; yet the entire country was affected. Rondônia was the most affected state, with 67% decline. The proportion of women presenting palpable lumps increased from 7.06% on average in 2019 to 7.94% in 2020 (OR = 1.135, 95%CI 1.125–1.145, p = 0,001). DISCUSSION: The number of mammograms performed in 2020 declined considerably. Out of the women who presented for mammogram, the proportion of palpable lumps was significantly higher in 2020. Considering the detection rate of digital mammography, the loss of 800,000 exams means 4,000 undiagnosed breast cancer cases, by the end of 2020.
  • Performance and perception on front-of-package nutritional labeling models in Brazil Original Article

    Bandeira, Luisete Moraes; Pedroso, Jéssica; Toral, Natacha; Gubert, Muriel Bauermann

    Abstract in Portuguese:

    RESUMO OBJETIVO: Avaliar o desempenho e a percepção de cinco modelos de rotulagem nutricional frontal (RNF) entre consumidores brasileiros. MÉTODOS: Estudo transversal, com aplicação de questionário online a 2.400 indivíduos, alocados de forma aleatória em seis grupos de estudo, sendo um controle e cinco expostos a modelos de RNF (octógono, triângulo, círculo, lupa e semáforo), aplicados a nove alimentos. Foi avaliado o entendimento do conteúdo nutricional, a percepção de saudabilidade, a intenção de compra e a percepção dos consumidores brasileiros sobre os modelos. RESULTADOS: Todos os modelos de RNF aumentaram o entendimento do conteúdo nutricional e reduziram a percepção de saudabilidade e a intenção de compra, quando comparados ao grupo controle (41,3%). Os modelos de RNF de advertência - octógono (62,4%), triângulo (61,9%) e círculo (61,8%) - apresentaram desempenho significativamente superior ao semáforo (55,0%) quanto ao entendimento do conteúdo nutricional. O desempenho do modelo da lupa (59,5%) não diferiu dos outros quatro modelos testados, inclusive do semáforo (55,0%), para o entendimento do conteúdo nutricional. A análise individual dos alimentos sugere melhor desempenho das advertências em relação à lupa e ao semáforo para a percepção de saudabilidade e a intenção de compra. Os consumidores manifestam-se favoráveis à presença da RNF, percebendo-a como confiável para aumentar o entendimento das informações nutricionais. CONCLUSÃO: A RNF deve ser implementada nos rótulos dos alimentos no Brasil, considerando que aumenta o entendimento nutricional, reduz a percepção de saudabilidade e a intenção de compra de alimentos com nutrientes críticos. As advertências apresentaram melhor desempenho quando comparadas aos demais modelos.

    Abstract in English:

    ABSTRACT OBJECTIVE: To evaluate the performance and perception of five models of front-of-package nutrition labeling (FOPNL) among Brazilian consumers. METHODS: Cross-sectional study, which applied an online questionnaire to 2,400 individuals, allocated randomly into six study groups: a control group and five others exposed to FOPNL (octagon, triangle, circle, magnifier and traffic light), applied to nine products. We evaluated the understanding of nutritional content, the perception of healthiness, the purchase intention and the perception of Brazilian consumers on the models. RESULTS: All FOPNL models increased the understanding of the nutritional content and reduced the perception of healthiness and purchase intention, when compared with the control group (41.3%). FOPNL warning models — octagon (62.4%), triangle (61.9%) and circle (61.8%) — performed significantly better than the traffic light (55.0%) regarding the understanding of the nutritional content. The performance of the magnifier (59.5%) was similar to the other four tested models, including the traffic light (55.0%), for understanding nutritional content. The individual analysis of the products suggests a better performance of warnings in relation to the magnifier and the traffic light for the perception of healthiness and purchase intention. Consumers were favorable to the presence of FOPNL, perceiving it as reliable to increase the understanding to nutritional information. CONCLUSION: FOPNL must be implemented on food labels in Brazil, considering that it increases the nutritional understanding, reduces the perception of healthiness and the purchase intention of products with critical nutrients. Warnings showed a better performance when compared with other models.
  • Impact of COAP on access to primary care in Ceará and Mato Grosso do Sul through the analysis of interrupted time series Original Article

    Pires, Débora Castanheira; Campos, Mônica Rodrigues; Emmerrick, Isabel Martins

    Abstract in Portuguese:

    RESUMO OBJETIVO: Analisar o impacto da implementação do Contrato Organizativo de Ação Pública (COAP) sobre a ampliação do acesso à atenção básica nos estados do Ceará e Mato Grosso do Sul. MÉTODOS: Utilizou-se o método de séries temporais interrompidas para analisar o efeito do COAP sobre a cobertura da atenção básica (CobAB) e sobre as taxas de internação evitáveis. Para analisar os efeitos do aumento da CobAB sobre as internações evitáveis ao longo do tempo, foram utilizados modelos de séries temporais não segmentadas. RESULTADOS: Os resultados mostraram que a implementação do COAP teve impacto positivo sobre o aumento da cobertura nos dois casos, o que não aconteceu nos controles. Contudo, esse impacto não se refletiu na diminuição das taxas de internação por condições sensíveis à atenção básica (ICSAB) ou por causas evitáveis agudas. Quando analisamos os efeitos do aumento da CobAB sobre as internações evitáveis entre 2009 e 2016, observamos que a cobertura teve impacto positivo na diminuição da taxa de ICSAB apenas no Ceará, apesar de as internações terem tendência significativa de queda no tempo tanto neste estado quanto no Mato Grosso do Sul, exceto por infecções respiratórias agudas. CONCLUSÕES: O COAP continua sendo o instrumento regulador da regionalização vigente, contudo, os resultados obtidos pela adesão a ele na expansão da atenção básica no Ceará e no Mato Grosso do Sul fazem questionar se o modelo contratual, tal como previsto, é o melhor instrumento para o avanço da regionalização do Sistema Único de Saúde.

    Abstract in English:

    ABSTRACT OBJECTIVE: To analyze the impact of implementing the Contrato Organizativo de Ação Pública (COAP – Public Action Organizational Contract) on the expansion of access to primary care in the states of Ceará and Mato Grosso do Sul. METHODS: We used the interrupted time series method to analyze the effect of COAP on primary care coverage (PCCov) and on avoidable hospitalization rates. To analyze the effects of increased PCCov on avoidable hospitalizations, we used non-segmented time series models. RESULTS: The results showed that implementing COAP had a positive impact on increased coverage in both cases, with did not happen in the control states. However, this impact was not reflected in the decrease in hospitalizations due to primary care sensitive conditions (HPCSC) or for acute preventable causes. When we analyzed the effects of the increase in PCCov on avoidable hospitalizations between 2009 and 2016, we observed that coverage had a positive impact on the decrease in the rate of HPCSC only in Ceará, although hospitalizations have a significant trend to decrease in time both in this state and in Mato Grosso do Sul, except for acute respiratory infections. CONCLUSIONS: The COAP continues to be the regulatory instrument of regionalization force, however, the results obtained by adhering to it in the expansion of primary care in Ceará and Mato Grosso do Sul makes us question whether the contractual model, as predicted, is the best instrument for advancing regionalization in the Brazilian Unified Health System.
  • Breastfeeding patterns and factors associated with early weaning in the Western Amazon Original Article

    Martins, Fernanda Andrade; Ramalho, Alanderson Alves; Andrade, Andréia Moreira de; Opitz, Simone Perufo; Koifman, Rosalina Jorge; Silva, Ilce Ferreira da

    Abstract in Portuguese:

    RESUMO OBJETIVO: Caracterizar os padrões de amamentação nos primeiros seis meses de vida e fatores associados ao desmame precoce numa coorte de nascidos vivos em Rio Branco, Acre. MÉTODOS: Estudo prospectivo com nascidos vivos entre abril e junho de 2015. As entrevistas com as mães ocorreram logo após o nascimento e entre 6 e 15 meses pós-parto. Na alta hospitalar, o aleitamento foi definido em exclusivo (AME) e materno (AM). No seguimento, os padrões de amamentação foram AME, aleitamento materno predominante (AMP) e AM. A interrupção da amamentação nos primeiros seis meses foi classificada como desmame precoce. Utilizou-se o método de Kaplan Meier (log-rank: 95%) para estimar a probabilidade condicional de mudança no padrão de amamentação e risco de desmame. Os fatores associados ao desmame e seus intervalos de confiança de 95% (IC95%) foram analisados pela regressão proporcional de Cox bruta e ajustada. RESULTADOS: Participaram do estudo 833 lactentes que na alta hospitalar estavam em AME (95,4%) e AM (4,6%). A probabilidade do lactente em AME na alta hospitalar permanecer em AME, ou se tornar AMP ou AM, aos seis meses, foi de 16,4%, 32,3% e 56,5% respectivamente. A probabilidade de desmame aos seis meses foi estaticamente maior para lactentes em AM na alta hospitalar (47,4%) em comparação com aqueles em AME (26%). Mostraram-se associados ao desmame precoce: o AM na alta hospitalar (HR = 1,82; IC95% 1,06–3,11), ausência de amamentação cruzada praticada pela mãe (HR = 2,50; IC95% 1,59–3,94), usar chupeta (HR = 6,23; IC95% 4,52–8,60), pretender amamentar por menos de seis meses (HR = 1,93; IC95% 1,25–2,98), não amamentar na primeira hora de vida (HR = 1,45; IC95% 1,10–1,92) e consumir álcool na gestação (HR = 1,88; IC95% 1,34–2,90). CONCLUSÃO: Comparados aos lactentes em AME, aqueles em AM, na alta hospitalar, apresentaram maior probabilidade de desmame. Esforços em saúde pública devem priorizar o AME na alta hospitalar, promover amamentação na primeira hora de vida e orientar sobre os riscos do consumo de álcool na gestação, amamentação cruzada e uso de chupeta.

    Abstract in English:

    ABSTRACT OBJECTIVE: To characterize breastfeeding patterns in the first six months of life and factors associated with early weaning in a birth-cohort in Rio Branco, state of Acre. METHODS: This is a prospective study with all babies born between April and June 2015. The mothers were interviewed soon after birth and between 6 and 15 months postpartum. At hospital discharge, breastfeeding was defined as exclusively (EBF), and breastfeeding (BF). In the follow-up, breastfeeding patterns were exclusive breastfeeding (EBF), predominant breastfeeding (PBF), and breastfeeding (BF). The interruption of breastfeeding in the first six months was classified as early weaning. The Kaplan Meier method (log-rank: 95%) was used to estimate the conditional probability of change in breastfeeding pattern, and early weaning risk. Crude and adjusted proportional Cox regression models, and their respective 95% confidence intervals (95%CI), were used to analyze the factors associated with early weaning. RESULTS: The study included 833 infants in EBF (95.4%) and BF (4.6%) at hospital discharge. During the first six months of life, the infant likely discharged in EBF remaining in EBF, becoming PBF, and BF, were respectively 16.4%, 32.3%, and 56.5%. The weaning likely at six months was statistically higher for infants discharged in BF (47.4%) when compared with those discharged in EBF (26%). Factors associated with early weaning were BF at hospital discharge (HR = 1.82; 95%CI 1.06–3.11), no mother cross-breastfeeding (HR = 2.50; 95%CI 1.59–3.94), pacifier use (HR = 6.23; 95%CI 4.52–8.60), less than six months of breastfeeding intention (HR = 1.93; 95%CI 1.25–2.98), lack of breastfeeding in the first hour of life (HR = 1.45; 95%CI 1.10–1.92), and pregnancy alcohol consumption (HR = 1.88; 95%CI 1.34–2.90). CONCLUSION: Compared to infants in EBF, those in BF at hospital discharge were more likely to wean. Public health efforts should prioritize EBF at hospital discharge, promote breastfeeding in the first hour of life, and prevent alcohol consumption risks during pregnancy, cross-breastfeeding and pacifier use.
  • User satisfaction in relation to Primary Health Care services in Brazil Original Article

    Cantalino, Juliana Leal Ribeiro; Scherer, Magda Duarte dos Anjos; Soratto, Jacks; Schäfer, Antônio Augusto; Anjos, Davllyn Santos Oliveira dos

    Abstract in Portuguese:

    RESUMO OBJETIVO: Analisar a satisfação de usuários em relação ao acesso, à infraestrutura e à qualidade dos serviços na Atenção Primária à Saúde (APS) no Brasil. MÉTODOS: Estudo transversal com dados de 114.615 usuários vinculados a 30.523 equipes de saúde, obtidos por meio do banco de dados do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). Foram estudadas variáveis independentes relacionadas ao acesso, à infraestrutura e à qualidade dos serviços na APS. O desfecho, satisfação dos usuários, foi mensurado através das variáveis: “se tivesse a opção, mudaria de equipe ou de serviço de saúde” e “recomendaria este serviço de saúde para um amigo ou familiar”. Para avaliar a satisfação de acordo com as variáveis independentes de exposição, foi utilizado o teste Qui-quadrado de Pearson, considerando nível de significância de 5%. Análises descritivas das variáveis foram realizadas através de frequências absoluta (n) e relativa (%). RESULTADOS: A satisfação dos usuários esteve associada às variáveis de acesso (p < 0,001), infraestrutura (p < 0,001) e qualidade dos serviços (p < 0,001) na APS. A proximidade do serviço, atenção à demanda espontânea, escuta e o respeito dos profissionais às singularidades do paciente, assim como a resolutividade dos serviços, sem necessidade de encaminhamentos para outros e a boa infraestrutura, estiveram relacionados com a satisfação dos usuários. CONCLUSÃO: Para a garantia da melhoria da qualidade dos serviços ofertados na APS do Brasil, os aspectos de satisfação dos usuários identificados no presente estudo devem ser considerados na organização e gestão dos serviços.

    Abstract in English:

    ABSTRACT OBJECTIVE: To analyze user satisfaction in relation to access, infrastructure and quality of Primary Health Care (PHC) services in Brazil. METHODS: This cross-sectional study was conducted with data from 114,615 users linked to 30,523 health teams, obtained through the database of the Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB —National Program for the Improvement of Access and Quality of Primary Care). Independent variables related to access, infrastructure and quality of services in PHC were studied. The outcome, user satisfaction, was measured using the variables: “if given the option, I would change the staff or health service” and “I would recommend this health service to a friend or family member.” To assess satisfaction according to independent exposure variables, Pearson’s chi-squared test was used, considering a significance level of 5%. Descriptive analyses of the variables were performed using absolute (n) and relative (%) frequencies. RESULTS: User satisfaction was associated with the variables of access (p < 0.001), infrastructure (p < 0.001) and quality of services (p < 0.001) in PHC. The proximity of the service, attention to spontaneous demand, listening and the respect of professionals to the singularities of the patient, as well as the problem-solving capacity of the services, without the need for referrals to others and the good infrastructure, were related to user satisfaction. CONCLUSION: To ensure the improvement of the quality of services offered in PHC in Brazil, the aspects of user satisfaction identified in this study should be considered in the organization and management of services.
  • Adverse events following immunization in pregnant women from Minas Gerais Original Article

    Silveira, Isabela Oliveira da; Silva, Thales Philipe Rodrigues da; Luvisaro, Bianca Maria Oliveira; Silva, Roberta Barros da; Gusmão, Josianne Dias; Vimieiro, Aline Mendes; Oliveira, Valéria Conceição de; Souza, Karina Cristina Rouwe de; Faria, Ana Paula Vieira; Matozinhos, Fernanda Penido

    Abstract in Portuguese:

    RESUMO OBJETIVO: Analisar a distribuição dos eventos adversos pós-vacinação (EAPV) em gestantes do estado de Minas Gerais, entre 2015 e 2019. MÉTODOS: Estudo epidemiológico, descritivo, realizado com dados de EAPV, do período de 2015 a 2019, registrados no Sistema de Informação da Vigilância de Eventos Adversos, no estado de Minas Gerais (MG), Brasil. Foram analisados 670 EAPV em gestantes. As estimativas foram apresentadas em proporções, de acordo com o ano de ocorrência, macrorregião de saúde de Minas Gerais e imunobiológico administrado. RESULTADOS: O ano em que mais houve registros foi 2017 (36,8%). Entre as 14 macrorregiões, as com menor e maior número de registros foram o Vale do Jequitinhonha (0,5%) e o Centro (31,8%), respectivamente. As vacinas contraindicadas durante a gestação representaram 27,6% do total de notificações. Foram considerados como erros de imunização 69,5% dos casos. Em 75,9% dos registros, a variável de atendimento médico foi ignorada, e em 73,7% dos casos não foi apresentada informação sobre a evolução. CONCLUSÃO: Este estudo expõe a necessidade da educação continuada para a equipe multidisciplinar, a fim de reduzir casos de EAPV e garantir o preenchimento adequado das notificações pelos profissionais de saúde.

    Abstract in English:

    ABSTRACT OBJECTIVE: To analyze the distribution of adverse events following immunization (AEFI) in pregnant women in the state of Minas Gerais, between 2015 and 2019. METHODS: This is an epidemiological, descriptive study conducted with AEFI data from 2015 to 2019, recorded in the Adverse Events Surveillance Information System, in the state of Minas Gerais (MG), Brazil. A total of 670 AEFI were analyzed in pregnant women. The estimates were presented in proportions, according to the year of occurrence, health macro-region of Minas Gerais and immunobiological administered. RESULTS: The year in which there were the most records was 2017 (36.8%). Among the 14 macro-regions, the ones with the lowest and highest number of records were the Vale do Jequitinhonha (0.5%) and Center (31.8%), respectively. The vaccines contraindicated during pregnancy represented 27.6% of the total notifications. The total of 69.5% of the cases were considered immunization errors. In 75.9% of the records, the variable of medical care was ignored, and in 73.7% of the cases no information on the evolution was presented. CONCLUSION: This study shows the need for continuing education for the multidisciplinary team, in order to reduce cases of AEFI and ensure the adequate completion of notifications by health professionals.
  • Oral health indicators and sociodemographic factors in Brazil from 2008 to 2015 Original Article

    Santos, Juliana Leandro dos; Ferreira, Raquel Conceição; Amorim, Leonardo de Paula; Santos, Anna Rachel Soares; Chiari, Antônio Paulo Gomes; Senna, Maria Inês Barreiros

    Abstract in English:

    ABSTRACT OBJECTIVE: To evaluate the annual variation of oral health and primary care coverage, the tooth extraction ratio, and the average of supervised toothbrushing in Brazilian municipalities according to social development and population size. METHODS: Public secondary data were analyzed. The outcomes were health service indicators (oral health coverage, primary health care coverage, tooth extraction ratio, and average of supervised tooth brushing) estimated for all Brazilian municipalities annually from 2008 to 2015. Mixed-effect multilevel regression models with random intercept and slopes were fitted with a cross-interaction term to estimate the annual percent variation according to the Municipal Human Development Index (MHDI) and population size. RESULTS: Municipalities with low MHDI presented an annual increase in oral health and primary care coverage of 2.65% and 2.23%, respectively, which was significantly higher than municipalities with medium and high MHDI. Oral health and primary care coverage were 69.26% and 35.00% lower among municipalities with a large population. Municipalities with medium and high MHDI showed an annual decrease in tooth extractions of 5.15% and 5.02%, respectively. An annual decrease was observed in the average of supervised toothbrushing of 9.81% and 4.57% in municipalities with low and medium MHDI, respectively. The tooth extraction ratio was higher among larger municipalities; the relation is inverse for supervised toothbrushing. CONCLUSIONS: The access to primary care and oral health services increased in Brazil, while a decrease occurred in mutilating treatment and provision of preventive actions, with disparities among municipalities with different MHDI levels over time.
  • Factors associated with prematurity in reported cases of congenital syphilis Original Article

    Araújo, Maria Alix Leite; Esteves, Ana Beatriz Barbosa; Rocha, Ana Fátima Braga; Silva Junior, Geraldo Bezerra da; Miranda, Angelica Espinosa

    Abstract in Portuguese:

    RESUMO OBJETIVO: Analisar os fatores associados à prematuridade em casos notificados de sífilis congênita no município de Fortaleza, Ceará, Brasil. MÉTODOS: Estudo transversal realizado em dez maternidades públicas de Fortaleza, Ceará, Brasil. Foram incluídos 478 casos notificados de sífilis congênita em 2015, e os dados foram coletados das fichas de notificação, dos prontuários das mães e dos bebês e do cartão de pré-natal. Para a análise bivariada, foram utilizados os testes do qui-quadrado de Pearson e exato de Fisher, considerando p < 0,05. Realizou-se regressão logística múltipla, apresentando razão de chances (OR) com intervalo de confiança de 95%. RESULTADOS: Encontrou-se 15,3% de prematuridade em gestantes com sífilis. A titulação do teste VDRL > 1:8 no parto (OR 2,46; IC95%: 1,33–4,53; p = 0,004), o não tratamento da gestante ou tratamento realizado com drogas diferentes da penicilina durante o pré-natal (OR 3,52; IC95%: 1,74–7,13; p < 0,001) estiveram associados a maiores chances de prematuridade. CONCLUSÃO: A prematuridade decorrente da sífilis congênita é um agravo evitável, desde que as gestantes com sífilis sejam tratadas adequadamente. As fragilidades na assistência pré-natal estão associadas a este desfecho, o que ressalta a importância de implementar políticas públicas voltadas a melhorar a qualidade do pré-natal.

    Abstract in English:

    ABSTRACT OBJECTIVE: To analyze the factors associated with prematurity in reported cases of congenital syphilis in the city of Fortaleza, Ceará, Brazil. METHODS: Cross-sectional study conducted in ten public maternity hospitals in Fortaleza, Ceará, Brazil. A total of 478 reported cases of congenital syphilis were included in 2015, and data were collected from notification forms, from mothers’ and babies’ medical records and from prenatal cards. For the bivariate analysis, Pearson’s chi-squared and Fisher’s exact tests were used, considering p < 0.05. Multiple logistic regression was conducted, presenting odds ratio (OR) with a 95% confidence interval. RESULTS: We found 15.3% prematurity in pregnant women with syphilis. The titration of the VDRL test > 1:8 at delivery (OR 2.46; 95%CI: 1.33–4.53; p = 0.004) and the non-treatment of the pregnant women or treatment with drugs other than penicillin during prenatal care (OR 3.52; 95%CI: 1.74–7.13; p< 0.001) were associated with higher chances of prematurity. CONCLUSION: The prematurity due to congenital syphilis is a preventable condition, provided that pregnant women with syphilis are treated appropriately. Weaknesses in prenatal care are associated with this outcome, which highlights the importance of public policies oriented to improve the quality of prenatal care.
  • Older adult health and primary care: autonomy, vulnerabilities and challenges of care Original Article

    Carneiro, Jeane Lima e Silva; Ayres, José Ricardo de Carvalho Mesquita

    Abstract in Portuguese:

    RESUMO OBJETIVO: Compreender as relações entre a autonomia e processos de saúde-doença-cuidado do idoso no cotidiano da atenção primária à saúde. MÉTODOS: Investigação qualitativa desenvolvida em 2019, em uma unidade básica de saúde da região central da cidade de São Paulo, utilizando observação participante e entrevistas em profundidade com 16 profissionais de saúde e 8 idosos. A construção e interpretação das narrativas produzidas no estudo foram orientadas pela perspectiva da hermenêutica filosófica de Gadamer e a teoria da interpretação de Ricoeur. O quadro teórico da vulnerabilidade/Cuidadoᵃ, tal como proposto por Ayres, orientou a definição do desenho do estudo e das categorias interpretativas. RESULTADOS: Estreitamente relacionada às dificuldades, facilidades e estratégias de enfrentamento dos desafios diários na atenção à saúde do idoso, a autonomia mostrou-se um importante marcador de vulnerabilidade (interpessoal, social e programática), indicando áreas que requerem atenção especial, como dispensação de medicamentos, mobilidade urbana, isolamento social, fragilidades financeiras e adequação das rotinas dos serviços. CONCLUSÃO: Distintamente de um atributo individual, a autonomia revelou-se expressão de características relacionais, exigindo estratégias, técnicas e horizontes prático-morais plurais e flexíveis, embora sempre orientados pelo mesmo compromisso ético de respeito às necessidades singulares dos indivíduos.

    Abstract in English:

    ABSTRACT OBJECTIVE: To understand the relations between autonomy and health-disease-care processes of older adults in the daily life of primary health care. METHODS: Qualitative research developed in 2019, in a primary health unit in the central region of the city of São Paulo, using participant observation and in-depth interviews with 16 health professionals and 8 older adults. The construction and interpretation of the narratives produced in the study were guided by the perspective of Gadamer’s philosophical hermeneutics and Ricoeur’s theory of interpretation. The theoretical framework of vulnerability/Careᵃ, as proposed by Ayres, guided the definition of the study and interpretative categories. RESULTS: Closely related to the difficulties, facilities and strategies to cope with the daily challenges in the health care of older adults, autonomy was an important marker of vulnerability (interpersonal, social and programmatic), indicating areas that require special attention, such as drug dispensing, urban mobility, social isolation, financial frailties and adequacy of service routines. CONCLUSION: Distinctly from an individual attribute, autonomy has proved to be the expression of relational characteristics, requiring plural and flexible practical-moral strategies, techniques and horizons, although always guided by the same ethical commitment to respect the singular needs of individuals.
  • Prediction of low birth weight with hypoglycemia in glucose tolerance test Original Article

    Hernández-Castro, Flavio; Berlanga-Garza, Anaís; Cruz-Gutiérrez, Mayela Diamantina; Soria-López, Juan Antonio; Villagómez-Martínez, Gabriel Edgar; Dávila-Escamilla, Iván Vladimir

    Abstract in Spanish:

    RESUMEN OBJETIVO: Determinar el valor de la combinación de la glucosa en ayunas menor que el percentil 10 (GA < p10) durante la prueba de tolerancia oral a la glucosa con 75 gramos (PTG-75g) con características maternas para predecir bajo peso al nacer (BPN) establecido mediante tablas de Intergrowth-21st. MÉTODOS: Estudio de cohorte prospectivo de mujeres embarazadas que se realizaron PTG-75g entre las 24 y 28.6 semanas. Se determinó el percentil 10 de glucosa en ayunas de la población en 65 mg/dL y fueron excluidas aquellas mujeres con factores de riesgo que pudieran modificar el peso fetal incluyendo los relacionados con la restricción del crecimiento intrauterino. Se formaron dos grupos: grupo GA < p10 y grupo con glucosa en ayunas normal. El hallazgo principal fue el diagnóstico de BPN. La asociación entre GA < p10, características maternas y BPN se estableció mediante regresión logística multivariante. El desempeño predictivo de los modelos construidos fue evaluado por el análisis de la curva característica operativa del receptor (ROC) y del área bajo la curva (ABC). RESULTADOS: Fueron elegibles para estudio 349 mujeres, de las cuales 66 (18,91%) tuvieron GA < p10; los neonatos de este grupo tuvieron pesos al nacer más bajos (2947.28 g y 3138.26 g, p = 0,001), frecuencias más altas de BPN (25% y 6,81%, p < 0,001) y de pesos < 2500 g en nacimientos de término (8,6% y 2,3%, p = 0,034). El modelo basal de predicción consistió en nuliparidad al lograr un ABC del 60%, mientras que al añadir la GA < p10 se obtuvo la mejora significativa del modelo previo (ABC 72%, DeLong: p = 0,005). CONCLUSIONES: En mujeres embarazadas sin factores que pudieran modificar el peso fetal, el modelo predictivo creado combinando GA < p10 durante la PTG-75g con nuliparidad estuvo asociado significativamente con riesgo incrementado de BPN. REGISTRO: ClinicalTrials.gov: NCT04144595.

    Abstract in English:

    ABSTRACT OBJECTIVE: Determine the value of the combination of fasting glucose less than the 10th percentile (FG < p10) during 75 gram oral glucose tolerance test (75g OGTT) with maternal characteristics to predict low birth weight (LBW) established by Intergrowth-21st tables. METHODS: Prospective cohort study of pregnant women who was underwent 75g OGTT between 24 and 28.6 weeks. The 10th percentile fasting glucose of the population was determined at 65 mg/dL and women with risk factors that could modify fetal weight, including those related to intrauterine growth restriction, were excluded. Two groups were formed: group FG < p10 and group with normal fasting glucose. The main finding was the diagnosis of LBW. The association between FG < p10, maternal characteristics and LBW was established by multivariate logistic regression. The predictive performance of the models constructed was evaluated by receiver operating characteristic (ROC) curve and area under the curve (AUC) analysis. RESULTS: 349 women were eligible for study, of whom 66 (18.91%) had FG < p10; neonates in this group had lower birth weights (2947.28 g and 3138.26 g, p = 0.001), higher frequencies of LBW (25% and 6.81%, p < 0.001) and of weights < 2500 g in term births (8.6% and 2.3%, p = 0.034). The basal prediction model consisted of nulliparity by achieving an AUC of 60%, while the addition of FG < p10 resulted in the significant improvement of the previous model (AUC 72%, DeLong: p = 0.005). CONCLUSIONS: In pregnant women without factors that could modify fetal weight, the predictive model created by combining FG < p10 during 75g OGTT with nulliparity was significantly associated with increased risk of LBW. REGISTRATION: ClinicalTrials.gov: NCT04144595.
  • Diet and supplement assessment in a Brazilian urban population Original Article

    Sousa, Alessandra Gaspar; Costa, Teresa Helena Macedo da

    Abstract in English:

    ABSTRACT OBJECTIVE: To assess total usual nutrient intakes from foods and dietary supplements by age, sex, physical activity, and nutritional status, and to compare usual nutrient intakes to the Dietary Reference Intakes among non-users and users of dietary supplements in an urban population. METHODS: Cross-sectional population-based survey with 506 adults conducted in the city of Brasília, Brazil, using 24h food recalls. The 24-HR was collected on two nonconsecutive days, for which individuals reported all food, supplements, and beverages consumed in the previous 24 hours. The estimates of mean and the distribution percentiles were adjusted to reflect usual nutrient intake using the Iowa State University method. The prevalence of inadequate micronutrient intake was estimated according to sex using the Estimated Average Requirement (EAR), and values above the Tolerable Upper Intake Level (UL) were also considered. Also, a comparison was made of the total mean usual intake between supplement users and non-users according to BMI and physical activity. RESULTS: The total mean usual dietary intake was significantly higher among users than non-users of dietary supplements (p ≤ 0.02). Dietary supplement use increased intakes of nutrients and decreased prevalence of inadequacy according to sex, with only small (typically < 13%) increases in the population exceeding the Tolerable Upper Intake Level. There was a significant interaction between physical activity and BMI categories with supplement use. CONCLUSIONS: The population that consumes food supplements comprises individuals with more advanced age, female, normal BMI, and physically active. Our findings show that the use of supplements appears beneficial to attain nutrient adequacy. Careful monitoring of intake from food and supplements is recommended, and the statistical methods must be powerful enough to achieve relevant information.
  • Analysis of the AUDIT factor structure in adolescents between 18 and 19 years Original Article

    Machado, Patrícia Maria Abreu; Campelo, Cleber Lopes; Oliveira, João Victor Pimentel de; Batista, Rosângela Fernandes Lucena; Simões, Vanda Maria Ferreira; Santos, Alcione Miranda dos

    Abstract in Portuguese:

    RESUMO OBJETIVO: Determinar a estrutura fatorial do instrumento Alcohol Use Disorders Identification Test (Audit) em uma amostra representativa de adolescentes de 18 a 19 anos. MÉTODOS: Estudo transversal realizado com adolescentes nascidos em São Luís (MA). A consistência interna do instrumento foi determinada pelo coeficiente alfa de Cronbach e a validade do construto foi avaliada por meio da Análise Fatorial Confirmatória (AFC). O índice de Kaiser-Meyer-Olkin (KMO) foi calculado para analisar a adequação da amostra. A qualidade de ajuste do modelo fatorial foi analisada de acordo com os índices dos testes qui-quadrado de ajustamento, comparative fit index (CFI), Tucker-Lewis index (TLI) e root mean square error of approximation (RMSEA). RESULTADOS: A amostra do estudo foi composta por 1.002 adolescentes entre 18 e 19 anos, sendo 56,8% meninas, 68,5% com 18 anos, 63,3% pardos ou mulatos, 48,6% pertencentes à classe C, 15,4% não trabalhavam e não estudavam e 52,1% tinham pais separados. A amostra foi adequada para a análise fatorial confirmatória (KMO = 0,79) e o coeficiente do alfa de Cronbach foi de 0,70, demostrando consistência interna satisfatória com cargas fatoriais acima de 0,5, com exceção do item 9 “Ficou ferido ou ficou alguém ferido por ter bebido”. A análise fatorial confirmatória revelou a validade do modelo de três fatores para a amostra em estudo com base nos índices de ajustes psicométricos. CONCLUSÃO: A estrutura fatorial do Audit com três fatores foi confirmada para a população de adolescentes entre 18 e 19 anos residentes em São Luís, ratificando os domínios conceituais originais propostos pela Organização Mundial da Saúde. O Audit apresentou-se como um instrumento confiável para a identificação do consumo de álcool.

    Abstract in English:

    ABSTRACT OBJECTIVE: To determine the factor structure of the instrument Alcohol Use Disorders Identification Test (AUDIT) in a representative sample of adolescents aged 18 to 19 years. METHODS: Cross-sectional study performed with adolescents born in São Luís (MA). The internal consistency of the instrument was determined by the Cronbach's alpha coefficient, and the validity of the construct was assessed by Confirmatory Factor Analysis (CFA). The Kaiser-Meyer-Olkin (KMO) was estimated to analyze the adequacy of the sample. The fit quality of the factor model was analyzed according to the indexes of the Chi-square adjustment test, comparative fit index (CFI), Tucker-Lewis index (TLI) and root mean square error of approximation (RMSEA). RESULTS: The sample of the study was composed of 1,002 adolescents aged from 18 to 19 years, being 56.8% girls, 68.5% with 18 years, 63.3% brown, 48.6% belonging to class C, 15.4% did not work or did not study, and 52.1% had divorced parents. The sample was suitable for confirmatory factor analysis (KMO = 0.79); Cronbach's alpha coefficient was 0.70, demonstrating satisfactory internal consistency with factor loads above 0.5, except for item 9, “was injured or someone else was injured due to drinking.” Confirmatory factor analysis revealed the validity of the three-factor model for the studied sample based on the indices of psychometric adjustments. CONCLUSION: The three-factor AUDIT factor structure was confirmed for the population of adolescents between 18 and 19 years old living in São Luís, ratifying the original conceptual domains proposed by the World Health Organization. AUDIT proved to be a reliable instrument to identify the consumption of alcohol.
  • Equity policies in health plans: accessibility and something more? Original Article

    Buceta, Bran Barral; Lorenzo, Ramón Bouzas; Ramos, Andrés Cernadas; Silva, Ángela Fernández da

    Abstract in Spanish:

    RESUMEN OBJETIVO: Examinar el enfoque adoptado por los planes de salud de las comunidades autónomas de España verificando el peso otorgado al concepto de equidad; detectar a qué colectivos o situaciones se hace referencia; así como distinguir la perspectiva de abordaje del mismo, desde el acceso, la igualación o la equiparación. MÉTODOS: Estudio cualitativo, de análisis de contenido mediante Nvivo12, realizado en 2020 sobre planes de salud en vigencia a fecha de 2019 en las diferentes regiones (comunidades autónomas) de España. Se han recopilado 16 planes de salud regionales vigentes para establecer categorías base (equidad, accesibilidad e igualdad) y determinar términos asociados a través de Nvivo12, a partir de los que se realizó un análisis de contenido. RESULTADOS: El concepto de equidad no resulta destacado por los planes de salud autonómicos y su relevancia es superada por los conceptos de accesibilidad e igualdad. El empleo de estos tres conceptos está asociado a diversas categorías que connotan circunstancias, condiciones o colectivos a los que los planes prestan mayor atención. CONCLUSIONES: Los resultados obtenidos coinciden con estudios previos sobre los contenidos y orientación de los planes de salud, revelando una presencia discreta del concepto de equidad en los enfoques adoptados, sin que ello menoscabe el alineamiento de las políticas de salud respecto de las visiones emanadas de organizaciones transnacionales. Se detecta la existencia de un colectivo al que se presta especial atención desde el enfoque de accesibilidad, la población con diversidad funcional.

    Abstract in English:

    ABSTRACT OBJECTIVE: To examine the approach adopted by the health plans of the autonomous communities of Spain, verifying the weight given to the concept of equity; to detect referenced communities or situations, as well as to distinguish the perspective of approaching it, from access, equity or equalization. METHODS: Qualitative study, of content analysis using Nvivo12, carried out in 2020 on health plans in force since 2019 in the different regions (autonomous communities) of Spain. Sixteen current regional health plans were compiled to establish base categories (equity, accessibility and equality) and determine associated terms using Nvivo12, from which a content analysis was performed. RESULTS: The concept of equity is not emphasized in the regional health plans and its relevance is surpassed by the concepts of accessibility and equality. The use of these three concepts is associated with various categories indicating circumstances, conditions or groups to which the plans give greater attention. CONCLUSIONS: The results obtained coincide with previous studies on the contents and orientation of health plans, revealing a discrete presence of the concept of equity in the approaches adopted, although this does not undermine the alignment of health policies with the visions emanating from transnational organizations. It is detected the existence of a group to which special attention is given from the accessibility approach, the population with functional diversity.
  • Nonadherence to immunosuppressives and treatment in kidney transplant: ADHERE BRAZIL Study Original Article

    Marsicano-Souza, Elisa Oliveira; Colugnati, Fernando; Geest, Sabina De; Sanders-Pinheiro, Helady

    Abstract in English:

    ABSTRACT OBJECTIVE To estimate the prevalence and variability of nonadherence to immunosuppressives and nonpharmacological treatment across kidney transplantation centers and two health access-disparate regions in Brazil. METHODS In a cross-sectional design, a random multistage sample of 1,105 patients was included, based on center transplantation activity (low/moderate/high) and region (R1: North/Northeast/Mid-West; and R2: South/Southeast). Nonadherence to immunosuppressives (implementation phase) was assessed using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS)©. Self-report questionnaires assessed nonadherence to physical activity, smoking cessation, alcohol intake, and appointment keeping. We compared regions using the adjusted-χ2 or t-test. RESULTS Most patients were men (58.5%), white (51.4%), and had a mean age of 47.5 (SD = 12.6) years. Regarding kidney transplantation centers, 75.9% were from R2 and 38.2% had low activity. The patients in R2 were older, white-majority, had more frequently steady partners, and received peritoneal dialysis. Nonadherence to immunosuppressives ranged from 11–65.2%; 44.5–90% to physical activity; 0–23.7% to appointment keeping; and 0–14% to smoking cessation. The total prevalence of nonadherence and by region (R1 versus R2) were: for immunosuppressives, 39.7% (44.9% versus 38.1%, p = 0.18); for smoking, 3.9% (1% versus 5%, p < 0.001); for physical activity, 69.1% (71% versus 69%, p = 0.48); for appointment keeping, 13% (12.7% versus 12%, p = 0.77); and for alcohol consumption, 0%. CONCLUSION Despite differences among centers and high variability, only the nonadherence to smoking cessation was higher in the region with greater access to kidney transplantation. We suppose that differences in healthcare access may have been overcome by other positive aspects of the post kidney transplantation treatment.
  • COVID-19 in northeast Brazil: first year of the pandemic and uncertainties to come Original Article

    Kerr, Ligia Regina Franco Sansigolo; Kendall, Carl; Almeida, Rosa Lívia Freitas de; Ichihara, Maria Yury; Aquino, Estela Maria L; Silva, Antônio Augusto Moura da; Ximenes, Ricardo Arraes de Alencar; Albuquerque, Maria de Fatima Pessoa Militão de; Almeida-Filho, Naomar; Souza, Rafael Felipe; Brandão Filho, Sinval Pinto; Souza, Wayner Vieira de; Barreto, Maurício Lima

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar a epidemia da covid-19 na região Nordeste do Brasil, uma das mais atingidas por essa virose. MÉTODOS Os dados oficiais para covid-19 dos estados do Nordeste são referentes ao período de março de 2020 a março de 2021. A análise para capitais e estados da série do acumulado semanal de casos e de óbitos confirmados foi feita com emprego do aplicativo JoinPoint Trend Analysis. RESULTADOS Em um ano, o Nordeste acumulou 22,9% dos casos e 21,5% dos óbitos do país pela covid-19. No início da pandemia, todos os estados apresentaram um crescimento sustentável de casos, primeiro nas capitais e depois interior. Em seguida, observam-se decréscimos em todos os estados e suas capitais, porém muitos permanecem com números elevados. Em meados do segundo semestre de 2020, o número de casos começa a crescer nos estados e suas capitais, alguns em velocidade explosiva, em especial no final de 2020 e início de 2021. Padrão similar é observado para os óbitos, os quais ultrapassaram ou aproximam-se do teto observado na primeira onda, na qual todas as capitais e estados do Nordeste adotaram intensas medidas de isolamento. Fortaleza, Recife e Teresina atingiram os maiores índices de isolamento de todas as capitais, perto de 0,60. Esse índice decresce, com tendência leve de crescimento até final de dezembro, voltando a decrescer. Com exceção de Fortaleza e Salvador, as demais capitais caíram para menos de 0,40. CONCLUSÃO O Nordeste brasileiro e o país estão em uma situação sanitária, social e econômica cada vez mais complexa. É necessário acelerar o processo de vacinação e manter as medidas não farmacológicas – constante uso de máscaras faciais, medidas de distanciamento e cuidados de higiene –, além de políticas de proteção aos trabalhadores que perderam as suas rendas e subsídios aos pequenos empresários.

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze the epidemic of COVID-19 in northeastern Brazil, one of the regions most affected by the virus. METHODS The official data for COVID-19, from March 2020 to March 2021 in the states of the Northeast Region (NE), were used. The analysis of capital cities and states for accumulated weekly cases and confirmed deaths was made using the JoinPoint Trend Analysis application. RESULTS In one year, the Northeast region reported 22.9% of the cases and 21.5% of the deaths in the country due to COVID-19. At the beginning of the pandemic, all states showed a growing number of cases, first in the capitals and then in the interior. Following this wave, decreases are observed in all states and their capitals, but with many still reporting a large number of cases. In the middle of the 2nd semester of 2020 the number of cases begins to increase again simultaneously in states and their capitals—some at explosive speed—especially in late 2020 and early 2021. A similar pattern is observed in deaths, which exceed or approach the peak seen in the first wave. In the first wave, all capitals and northeastern states adopted intense isolation measures. Fortaleza, Recife and Teresina reached the highest isolation index of all capitals, close to 0.60. This index decreases, with a slight growth trend until the end of December. With the exception of Fortaleza and Salvador, the other capitals fell to less than 0.40. CONCLUSION The Brazilian NE and the country are in increasingly complicated health, social and economic situations. It is necessary to speed up vaccinations and maintain non-pharmacological measures: face masks, social distancing measures and hygiene care, in addition to policies to protect workers who have lost their incomes and to subsidize small business owners.
  • COVID-19 and mental health of pregnant women in Ceará, Brazil Original Article

    Machado, Márcia Maria Tavares; Rocha, Hermano Alexandre Lima; Castro, Marcia C.; Sampaio, Edgar Gomes Marques; Oliveira, Francisco Ariclene; Silva, Jordan Prazeres Freitas da; Aquino, Camila Machado de; Sousa, Liduina de Albuquerque Rocha de; Carvalho, Francisco Herlanio Costa; Altafim, Elisa Rachel Pisani; Correia, Luciano Lima

    Abstract in English:

    ABSTRACT OBJECTIVE To assess the perceptions of pregnant women about COVID-19 and the prevalence of common mental disorders during the implemented social distancing period. METHODS This was an observational, cross-sectional study using digital media, of pregnant women exposed to social distancing due to the COVID-19 pandemic, in Fortaleza, Ceará, Northeastern Brazil. Common mental disorders were estimated using the modified Self-Report Questionnaire-20 (SRQ-20) scale, and the feelings towards COVID-19 were assessed using the Fear of COVID-19 scale through telephone calls made in May 2020. COX multivariate regression models were used to verify the associations. RESULTS Of the 1,041 pregnant women, 45.7% (95%CI: 42.7–48.8) had common mental disorders (CMD). All items of the Fear of COVID-19 Scale showed a significant association with the prevalence of CMD (p < 0.001). A CMD risk gradient was observed, going from a prevalence ratio of 1.52 (95%CI: 1.13–2.04) in pregnant women with two positive items to 2.70 (95%CI: 2.08–3.51) for those with four positive items. Early gestational age and the lack of prenatal care were also associated with CMD. CONCLUSIONS The prevalence of common mental disorders in pregnant women was high during the period of social distancing and was aggravated by negative feelings towards COVID-19.
  • Chronic non-communicable diseases and COVID-19: EPICOVID-19 Brazil results Original Article

    Mesenburg, Marilia Arndt; Hallal, Pedro Curi; Menezes, Ana Maria Baptista; Barros, Aluísio J D; Horta, Bernardo Lessa; Barros, Fernando Celso de; Hartwig, Fernando Pires; Jacques, Nadège; Silveira, Mariangela Freitas da

    Abstract in Portuguese:

    RESUMO OBJETIVO Descrever a prevalência de doenças crônicas e fatores socioeconômicos e demográficos associados, avaliar os padrões de distanciamento social e a prevalência de anticorpos contra SARS-CoV-2 e sintomas de covid-19 em portadores e não portadores de doenças crônicas. MÉTODOS Foram avaliados dados de 77.075 mil indivíduos de 20 a 59 anos de três etapas do inquérito sorológico de abrangência nacional Epicovid-19 Brasil, realizadas entre maio e junho de 2021. A presença de anticorpos contra SARS-CoV-2 foi avaliada por teste rápido. Foram investigadas as prevalências autorreferidas de hipertensão, diabetes, asma, câncer, doença renal crônica e doença cardíaca. A prevalência de uso de máscara, de adesão a medidas de isolamento e de anticorpos foi avaliada separadamente entre portadores e não portadores de doenças crônicas. A prevalência de sintomas foi avaliada entre doentes crônicos e não doentes portadores de anticorpos. RESULTADOS A prevalência do pelo menos uma doença crônica foi de 43%, maior na região Sudeste, entre indivíduos brancos e indígenas, mulheres, menos escolarizados e em menor posição socioeconômica. O uso de máscara ao sair do domicílio não diferiu entre doentes crônicos e não doentes (98%). A proporção de participantes que referiram adesão ao isolamento foi maior entre doentes crônicos (15,9%) que entre não doentes (24,9%). A prevalência de anticorpos contra SARS-CoV-2 foi semelhante entre doentes crônicos e não doentes (2,4% e 2,3%). A prevalência de tosse, dispneia, palpitações e mialgia foi significativamente maior entre doentes crônicos, mas a proporção de sintomáticos não diferiu entre os grupos. CONCLUSÃO A prevalência de doenças crônicas no país é alta e a pandemia de covid-19 atinge de forma semelhante doentes e não doentes. Doentes crônicos apresentam formas mais graves de covid-19 e maior prevalência de sintomas. A maior adesão às medidas de distanciamento social entre doentes crônicos não se reflete em menor incidência de covid-19 nesse grupo.

    Abstract in English:

    ABSTRACT OBJECTIVE Describing the prevalence of chronic diseases and associated socioeconomic and demographic factors, evaluating the patterns of social distancing and the antibodies prevalence against SARS-CoV-2 and COVID-19 symptoms in carriers and non-carriers of chronic diseases. METHODS Data from 77,075 individuals aged 20 to 59 from three steps of the EPICOVID-19 Brazil (a nationwide serological survey conducted between May and June, 2021) were assessed. The presence of antibodies against SARS-CoV-2 was examined by rapid tests. Self-reported prevalence of hypertension, diabetes, asthma, cancer, chronic kidney disease and heart disease were investigated. The prevalence of mask use, adherence to isolation measures and antibodies were evaluated separately amid carriers and non-carriers of chronic diseases. The prevalence of symptoms was analyzed among carriers and non-carriers of chronic diseases with antibodies. RESULTS The prevalence of at least one chronic disease was 43%, higher in the Southeast region, among white and indigenous individuals, women, less schooled and in lower socioeconomic position. The use of masks when leaving home was similar among carriers and non-carriers of chronic diseases (98%). The proportion of participants who reported adherence to isolation measures was higher amid carriers (15.9%) than non-carriers (24.9%) of chronic diseases. The prevalence of antibodies to SARS-CoV-2 was similar amongst carriers and non-carriers (2.4% and 2.3%). The prevalence of cough, dyspnea, palpitations and myalgia was significantly higher among carriers, but the proportion of symptomatic patients was similar between groups. CONCLUSION The prevalence of chronic diseases in Brazil is high and the COVID-19 pandemic affects carriers and non-carriers of chronic diseases similarly. Carriers present more severe forms of COVID-19 and higher prevalence of symptoms. Greater adherence to social distancing measures among chronic patients is disassociated from a lower incidence of COVID-19 in this group.
  • Prediction of absenteeism in public schools teachers with machine learning Original Article

    Fernandes, Fernando Timoteo; Chiavegatto Filho, Alexandre Dias Porto

    Abstract in Portuguese:

    RESUMO OBJETIVO Predizer o risco de ausência laboral decorrente de morbidades dos docentes que atuam na educação infantil na rede pública municipal, com o uso de algoritmos de machine learning. MÉTODOS Trata-se de um estudo transversal utilizando dados secundários, públicos e anônimos da Relação Anual de Informações Sociais, selecionando professores da educação infantil que atuaram na rede pública municipal do estado de São Paulo entre 2014 e 2018 (n = 174.294). Foram também vinculados dados da média de alunos por turma e número de habitantes no município. Os dados foram separados em treinamento e teste, utilizando os registros de 2014 a 2016 (n = 103.357) para treinar cinco modelos preditivos e os dados de 2017 a 2018 (n = 70.937) para testar seus desempenhos em dados novos. A performance preditiva dos algoritmos foi avaliada por meio do valor da área abaixo da curva ROC (AUROC). RESULTADOS Todos os cinco algoritmos testados apresentaram área abaixo da curva acima de 0,76. O algoritmo com melhor performance preditiva (redes neurais artificiais) obteve 0,79 de área abaixo da curva, com acurácia de 71,52%, sensibilidade de 72,86%, especificidade de 70,52% e kappa de 0,427 nos dados de teste. CONCLUSÃO É possível predizer casos de afastamentos por morbidade em docentes da rede pública com machine learning usando dados públicos. O melhor algoritmo apresentou melhor resultado da área abaixo da curva quando comparado ao modelo de referência (regressão logística). Os algoritmos podem contribuir para predições mais assertivas na área da saúde pública e da saúde do trabalhador, permitindo acompanhar e ajudar a prevenir afastamentos por morbidade desses trabalhadores.

    Abstract in English:

    ABSTRACT OBJECTIVE To predict the risk of absence from work due to morbidities of teachers working in early childhood education in the municipal public schools, using machine learning algorithms. METHODS This is a cross-sectional study using secondary, public and anonymous data from the Relação Anual de Informações Sociais, selecting early childhood education teachers who worked in the municipal public schools of the state of São Paulo between 2014 and 2018 (n = 174,294). Data on the average number of students per class and number of inhabitants in the municipality were also linked. The data were separated into training and testing, using records from 2014 to 2016 (n = 103,357) to train five predictive models, and data from 2017 to 2018 (n = 70,937) to test their performance in new data. The predictive performance of the algorithms was evaluated using the value of the area under the ROC curve (AUROC). RESULTS All five algorithms tested showed an area under the curve above 0.76. The algorithm with the best predictive performance (artificial neural networks) achieved 0.79 of area under the curve, with accuracy of 71.52%, sensitivity of 72.86%, specificity of 70.52%, and kappa of 0.427 in the test data. CONCLUSION It is possible to predict cases of sickness absence in teachers of public schools with machine learning using public data. The best algorithm showed a better result of the area under the curve when compared with the reference model (logistic regression). The algorithms can contribute to more assertive predictions in the public health and worker health areas, allowing to monitor and help prevent the absence of these workers due to morbidity.
  • Improvement of quality of care for gestational syphilis in the municipality of Rio de Janeiro Original Article

    Cerqueira, Brena Gabriella Tostes de; Silva, Eliane Pereira da; Gama, Zenewton André da Silva

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar o efeito de uma intervenção multifacetada no cuidado das gestantes com sífilis na atenção primária à saúde. MÉTODOS Trata-se de projeto de melhoria da qualidade realizado em 26 unidades básicas de saúde do município do Rio de Janeiro, entre janeiro e dezembro de 2017. O desenho foi quase-experimental misto, com análises anteriores, posteriores e de série temporal. Avaliou-se o cuidado prestado a todas as gestantes com sífilis e pré-natal encerrado no período, mediante dez critérios de qualidade e um indicador. A intervenção foi multifacetada, abrangendo educação permanente, melhoria dos registros e sistemas de informação, auditoria e feedback, educação do paciente, mudanças organizacionais e nos processos de trabalho. Estimaram-se as melhorias absoluta e relativa dos critérios e sua significância estatística (α = 5%). Os facilitadores e dificultadores da intervenção foram analisados segundo o Model for Understanding Success in Quality. RESULTADOS Após a intervenção, observou-se melhoria absoluta total de 6,7% (64,4% versus 71,0%) e relativa de 28,8% (p > 0,05). Oito dos dez critérios de qualidade tiveram melhoria, sendo esta significativa em quatro deles (p < 0,05). O indicador mensal de tratamento adequado também melhorou (p < 0,05), porém manteve baixo desempenho em todo o projeto. Destacou-se positivamente o aumento da conformidade do esquema de tratamento com o protocolo (91,4% versus 99,1%), porém as principais oportunidades de melhoria foram a testagem (42,8% versus 48,5%) e o tratamento das parcerias sexuais (42,8% versus 44,2%). Pressões regulatórias para melhorar o indicador mensal e a crise político-econômica vivenciada pelo município modularam o efeito da intervenção. CONCLUSÃO O projeto foi útil para identificar prioridades e orientar intervenções para a melhoria da qualidade da assistência à sífilis, embora ainda exista ampla margem para avanços. Os problemas identificados, bem como os moduladores contextuais do efeito, devem ser considerados em futuras intervenções.

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze the effect of a multifaceted intervention in the care of pregnant women with syphilis in primary health care. METHODS This is a quality improvement project performed in 26 basic care units in the municipality of Rio de Janeiro, between January and December 2017. It has a quasi-experimental mixed design, with previous, later and time series analyses. We evaluated the care provided to all pregnant women with syphilis whose prenatal care that ended during the studied period, using ten quality criteria and one indicator. The intervention was multifaceted, covering permanent education, improvement of records and information systems, audit and feedback, patient education, organizational changes and work processes. We estimated absolute and relative improvements of the criteria and their statistical significance (α = 5%). The facilitators and hinders of the intervention were analyzed according to the Model for Understanding Success in Quality. RESULTS After the intervention, there was a total absolute improvement of 6.7% (64.4% versus 71.0%) and relative of 28.8% (p > 0.05). Eight of the ten quality criteria had an improvement, which was significant in four of them (p < 0.05). The monthly indicator of adequate treatment also improved (p < 0.05), but maintained low performance throughout the project. The increase in the compliance of the treatment scheme with the protocol (91.4% versus 99.1%) positively stood out, but the main opportunities for improvement were testing (42.8% versus 48.5%) and treatment of sexual partnerships (42.8% versus 44.2%). Regulatory pressures to improve the monthly indicator and the political-economic crisis experienced by the municipality modulated the effect of the intervention. CONCLUSION The project was useful to identify priorities and guide interventions to improve the quality of care for syphilis, although there is still ample room for improvement. The identified problems, as well as the contextual modulators of the effect, should be considered in future interventions.
  • Estimation of chronic dietary intake of pesticide residues Original Article

    Marques, Jacqueline Mary Gerage; Silva, Marina Vieira da

    Abstract in Portuguese:

    RESUMO OBJETIVO Estimar a ingestão diária máxima teórica dos agrotóxicos potencialmente consumidos, de forma crônica, pela população brasileira. MÉTODO Utilizando os dados do bloco de consumo alimentar da Pesquisa de Orçamentos Familiares de 2008–2009 para caracterização da dieta da população, foi construído um banco de dados agrupando os alimentos com base na classificação NOVA. Considerando os valores de limite máximo de resíduos de cada agrotóxico autorizado no país até o ano de 2016, foram somados os limites de todos os alimentos consumidos, multiplicados pela quantidade consumida, gerando o índice de ingestão teórica máxima, que foi comparado com a ingestão diária aceitável. RESULTADOS Os resultados mostram que dos 283 agrotóxicos considerados no banco de dados, 71 compostos tiveram estimativas de ingestão zero (25%), 144 compostos (50,8%) atingiram aos valores de ingestão diária aceitável e 68 compostos (24%) apresentaram mediana de ingestão que excedeu o valor diário aceitável. Quando realizada a estimativa de ingestão de agrotóxicos discriminando as distintas regiões do país, houve variação (entre 48 e 69 substâncias) na quantidade de compostos que excederam a ingestão diária aceitável devido aos diferentes padrões de consumo da população. As categorias dos produtos que mais excederam as estimativas são inseticidas, herbicidas e fungicidas. CONCLUSÃO A aplicação dessa metodologia é válida para o primeiro passo na avaliação de risco, porém os valores resultantes podem ser diferentes da exposição real por não englobar outros fatores, como o uso combinado de agrotóxicos ou de produtos de uso não autorizado. É ressaltada a importância do desenvolvimento de pesquisas de dados específicos de consumo de alimentos nacionais de forma sistemática, gerando dados e análises que viabilizem uma avaliação pormenorizada sobre riscos.

    Abstract in English:

    ABSTRACT OBJECTIVE To estimate the maximum theoretical daily intake of pesticides potentially consumed, chronically, by the Brazilian population. METHOD By using data from the food consumption section of the 2008–2009 Household Budget Survey to characterize the population diet, a database was built to group the foods based on the NOVA classification. Considering the maximum residue limit values of each pesticide authorized in the country until 2016, the limits of all consumed foods were added and multiplied by the amount consumed, resulting in the maximum theoretical intake index, which was compared with the acceptable daily intake. RESULTS The results show that, of the 283 pesticides considered in the database, 71 (25%) compounds had estimates of zero intake, 144 compounds (50.8%) reached acceptable daily intake values and 68 compounds (24%) showed median intake that exceeded the acceptable daily value. The pesticide intake estimation according to the different regions of the country showed a variation in the amount of compounds that exceeded the acceptable daily intake (48 to 69 substances) due to the different consumption patterns. The categories of products that most exceeded the limits were the insecticides, herbicides and fungicides. CONCLUSION The application of this methodology is valid for the first step in risk assessment, but the resulting values may be different from the actual exposure since they do not include other factors, such as the combined use of pesticides or unauthorized products. The importance of developing research on specific national food consumption data in a systematic way is emphasized, which generates data and analyses that allow a detailed risk assessment.
  • Surveillance of hemorrhagic fever and/or neuroinvasive disease: challenges of diagnosis Original Article

    Araújo, Leonardo José Tadeu de; Gonzalez, Lorenzo Lang; Buss, Lewis Fletcher; Guerra, Juliana Mariotti; Gomez, David Salas; Ferreira, Camila Santos da Silva; Cirqueira, Cinthya Santos; Ghillardi, Fábio; Witkin, Steven S.; Sabino, Ester Cerdeira

    Abstract in English:

    ABSTRACT OBJECTIVE To evaluate the performance of post mortem laboratory analysis in identifying the causes of hemorrhagic fever and/or neuroinvasive disease in deaths by arbovirus infection. METHODS Retrospective cross-sectional study based on the differential analysis and final outcome obtained in patients whose samples underwent laboratory testing for arboviruses at the Pathology Center of the Adolfo Lutz Institute, in São Paulo, Brazil. RESULTS Of the 1355 adults clinically diagnosed with hemorrhagic fever and/or neuroinvasive disease, the most commonly attributed cause of death and the most common final outcome was dengue fever. Almost half of the samples tested negative on all laboratory tests conducted. CONCLUSION The failure to identify the causative agent in a great number of cases highlights a gap in the diagnosis of deaths of unknown etiology. Additional immunohistochemical and molecular assessments need to be added to the post-mortem protocol if all laboratory evaluations performed fail to identify a causative agent. While part of our findings may be due to technical issues related to sample fixation, better information availability when making the initial diagnosis is crucial. Including molecular approaches might lead to a significant advancement in diagnostic accuracy.
  • Influence of center-based child care on development of two-year-olds in a Brazilian cohort Original Article

    Leão, Otávio Amaral de Andrade; Mielke, Gregore Iven; Silveira, Mariângela Freitas da; Domingues, Marlos Rodrigues; Murray, Joseph; Neumann, Nelson Arns; Dalabona, Caroline Caus; Bertoldi, Andréa Dâmaso

    Abstract in English:

    ABSTRACT OBJECTIVE To investigate the association between child care attendance since birth and development in two-years-old Brazilian children. METHODS The study used longitudinal data from the 2015 Pelotas Birth Cohort. The childhood development (cognitive, fine and gross motor skills, and language) at two-years-old children was assessed using INTER-NDA (INTERGROWTH-21st Neurodevelopment Assessment). The child care attendance was measured at ages one and two years and categorized as: a) never attended child care; b) attended some child care (one or two years); and c) always attended child care (one and two years). Demographic, socioeconomic, health, and child stimulation variables were considered as confounders. Crude and adjusted analyses of child care attendance and development were carried out using linear regression. RESULTS Out of the 3,870 infants included in the analyses, around 1/3 attended center-based child care. In crude analyses, attending center-based child care was associated with positive developmental outcomes, except in motor domains. In adjusted analyses, compared to those children that have never attended child care, children who did attend presented higher scores for cognitive development (always in child care: β: 2.44, 95%CI: 0.83–4.05; some child care: β: 1.35, 95%CI: 0.17–2.53). CONCLUSIONS This study suggests that center-based child care may help improve child cognitive development in the Brazilian context. Furthermore, the association was higher for early and continued attendance. Considering the low prevalence of children in external care, it is recommended to improve child care opportunities in early childhood.
  • COVID-19 and social distancing among children and adolescents in Brazil Original Article

    Barros, Fernando C; Hartwig, Fernando P; Barros, Aluísio J D; Menezes, Ana M B; Horta, Bernardo L; Struchiner, Cláudio J; Vidaletti, Luis Paulo; Silveira, Mariangela F; Mesenburg, Marilia A; Delagostin, Odir A; Hallal, Pedro C; Victora, Cesar G

    Abstract in English:

    ABSTRACT OBJECTIVE To estimate the prevalence of SARS-CoV-2 antibodies and the adherence to measures of social distancing in children and adolescents studied in three national surveys conducted in Brazil between May–June 2020. METHODS Three national serological surveys were conducted in 133 sentinel cities located in all 27 Federative Units. Multistage probability sampling was used to select 250 individuals per city. The total sample size in age ranges 0–9 and 10–19 years old are of 4,263 and 8,024 individuals, respectively. Information on children or adolescents was gathered with a data collection app, and a rapid point-of-case test for SARS-CoV-2 was conducted on a finger prick blood sample. RESULTS The adjusted prevalence of antibodies was 2.9% (2.2–3.6) among children 0–9 years, 2.2% (1.8–2.6) among adolescents 10-19 years, and 3.0% (2.7–3.3) among adults 20+years. Prevalence of antibodies was higher among poor children and adolescents compared to those of rich families. Adherence to social distancing measures was seen in 72.4% (71.9–73.8) of families with children, 60.8% (59.6–61.9) for adolescents, and 57.4% (56.9–57.8) for adults. For not leaving the house except for essential matters the proportions were 81.7% (80.5–82.9), 70.6% (69.6–61.9), and 65.1% (64.7–65.5), respectively. Among children and adolescents, social distancing was strongly associated with socioeconomic status, being much higher in the better-off families. CONCLUSIONS The prevalence of antibodies against SARS-CoV-2 showed comparable levels among children, adolescents, and adults. Adherence to social distancing measures was more prevalent in children, followed by adolescents. There were important socioeconomic differences in the adherence to social distancing among children and adolescents.
  • Skills and practices of pharmacy staff for dispensing of drugs with fiscalized substances in drugstores and pharmacies Original Article

    Ceballos, Mauricio; Llano, Yaqueline; Salazar-Ospina, Andrea; Madrigal-Cadavid, Juliana; Pino-Marín, Daniel; Amariles, Pedro

    Abstract in English:

    ABSTRACT OBJETIVE To evaluate the skills and practices of pharmacy staff during the dispensing of tramadol (drug with fiscalized substance) in drugstores and pharmacies in Medellin, Colombia. METHODS A cross-sectional study was performed. The simulated patient technique was used. The main outcomes included the information provided on the dispensed drug (tramadol), the use of tools to provide information, and the information provided on drug precautions and use recommendations. RESULTS We visited 305 drugstores and pharmacies. The average dispensing time was 2.3 min (SD 1.1 min). In nine drugstores and pharmacies (3.0%), tramadol was not dispensed because it was not in stock. In 17 drugstores and pharmacies (5.7%), the simulated patients were actively informed by the dispensing pharmacy staff; of these, 16 provided oral information and one provided oral and written information. Eight patients (2.7%) received information regarding tramadol use. However, 99% of patients were not informed about tramadol side effects such as dependence, sedation, or hypnosis, and none of the simulated female patients were informed on the precautions related to tramadol use during pregnancy or lactation. CONCLUSIONS Communication skills and appropriate practices of pharmacy staff are critical to patient self-care. However, this study shows their difficulty in counseling about precautions and use recommendations of drugs with fiscalized substances. These outcomes could inform future studies focusing on the rational use of these drugs in drugstores and pharmacies. It is necessary to improve the pharmacy staff competencies through continuing education programs, to facilitate access to information and training.
  • Comorbidities and in-hospital death of viral pneumonia adults admitted to SUS (2002–2015) Original Article

    Piazza, Thais; Moreira, Daniela Pena; Rocha, Hugo André da; Lana, Agner Pereira; Reis, Ilka Afonso; Santos, Marcos Antônio da Cunha; Guerra-Júnior, Augusto Afonso; Cherchiglia, Mariangela Leal

    Abstract in English:

    ABSTRACT OBJECTIVE To identify demographic and clinical characteristics of adult patients hospitalized in the Brazilian Unified Health System (SUS) due to viral pneumonia and investigate the association between some comorbidities and death during hospitalization. METHODS This retrospective cohort study was conducted with secondary data of adults admitted to SUS due to viral pneumonia between 2002 and 2015. Patient profile was characterized based on demographic and clinical variables. The association between the ten Elixhauser comorbidities and in-hospital death was investigated using Poisson regression models with robust standard errors. Results were quantified as incidence rate ratio (IRR) with 95% confidence intervals (CI), and we built five models using successive inclusion of variables blocks. RESULTS Hospital admissions for viral pneumonias decreased throughout the study period, and it was observed that 5.8% of hospitalized patients had an in-hospital death. We observed significant differences in demographic and clinical characteristics by comparing individuals who died during hospitalization with those who did not, with the occurrence of one or more comorbidities being more expressive among patients who died. Although not considered risk factors for in-hospital death, chronic pulmonary disease and congestive heart failure were the most common comorbidities. Conversely, IRR for in-hospital death increased with other neurological disorders, diabetes, cancer, obesity, and especially with HIV/AIDS. CONCLUSIONS Individuals presenting with pulmonary and cardiovascular diseases require proper attention during hospitalization, as well as those with other neurological diseases, diabetes, cancer, obesity, and especially HIV/AIDS. Understanding the influence of chronic diseases on viral infections may support the healthcare system in achieving better outcomes.
  • Effectiveness of screening for tuberculosis in HIV: a pragmatic clinical trial Original Article

    Santos, Marcela Lopes; Batista, Joanna d’Arc Lyra; Braga, Cynthia; Silva, Adriana Paula da; Maruza, Magda; Souza, Wayner Vieira; Carvalho, Maria Rosimery de; Siqueira-Filha, Noemia Teixeira de; Albuquerque, Maria de Fátima Pessoa Militão de

    Abstract in English:

    ABSTRACT OBJECTIVE: To verify the effectiveness of screening for tuberculosis (TB) on all-cause mortality and tuberculosis cases in newly diagnosed HIV-infected patients through a clinical algorithm based on recommendations of the World Health Organization. METHODS: From March 2014 to April 2016, a pragmatic randomized clinical trial was conducted with newly diagnosed and TB-free HIV-infected adults undergoing antiretroviral therapy for up to one month at a major tertiary hospital for HIV in the state of Pernambuco, Brazil. Participants were randomized into intervention and control groups using an automatically-generated random list, and followed-up for at least 6 months. The intervention group was screened for TB at hospital admission and at every follow-up visit through a series of questions addressing TB-related symptoms (cough, fever, night sweating, and weight loss). Patients presenting with any of these symptoms were referred to a pulmonologist and underwent sputum smear microscopy, sputum culture, and rapid molecular testing (GeneXpert). When at least one test result came back positive, TB treatment was initiated. In turn, if patients tested negative but presented with severe clinal symptoms, TB preventive treatment was initiated. Screening for TB was not performed systematically in the control group. The primary outcome assessed in this study was death from all causes, and secondary outcomes included sensitivity and specificity of this screening test, as well as its detection time. RESULTS: This study evaluated 581 patients, 377 in the intervention group (64.9%) and 204 in the control group (35.1%). In total, 36 patients died during the follow-up period. Of these, 26 (6.9%) were from the intervention group, reaching a cumulative mortality coefficient of 69 per 1,000 inhabitants, and 10 (4.9%) from the control group (p = 0.341), with a cumulative mortality coefficient of 49 per 1,000 inhabitants (p = 0.341).
  • Consumption of ultra-processed foods and its association with sociodemographic factors in the adult population of the 27 Brazilian state capitals (2019) Original Article

    Costa, Caroline dos Santos; Sattamini, Isabela Fleury; Steele, Eurídice Martinez; Louzada, Maria Laura da Costa; Claro, Rafael Moreira; Monteiro, Carlos Augusto

    Abstract in Portuguese:

    RESUMO OBJETIVO Descrever a magnitude do consumo de alimentos ultraprocessados na população adulta (≥ 18 anos) das capitais das 27 unidades federativas do Brasil e sua associação com variáveis sociodemográficas. MÉTODOS Os dados utilizados neste estudo provêm dos participantes (n = 52.443) da onda 2019 do inquérito anual do “Sistema nacional de vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico” (Vigitel). O consumo de alimentos ultraprocessados foi descrito com base em escore correspondente à somatória de respostas positivas para questões sobre o consumo no dia anterior de treze subgrupos de alimentos ultraprocessados frequentemente consumidos no Brasil. Modelos de regressão de Poisson foram utilizados para descrever as associações bruta e ajustada do alto consumo de alimentos ultraprocessados (escores ≥ 5) com sexo, faixa etária e nível de escolaridade. RESULTADOS A frequência de alto consumo de alimentos ultraprocessados foi 18,2% (IC95% 17,4–19,0). Com ou sem o ajuste para as demais variáveis sociodemográficas, essa frequência foi significativamente menor no sexo feminino e diminuiu linearmente com a idade. Na análise bruta, evidenciou-se aumento na frequência de alto consumo do nível inferior para o nível intermediário de escolaridade e diminuição desse consumo do nível intermediário para o superior. Na análise ajustada por sexo e idade, a frequência de alto consumo de alimentos ultraprocessados foi significativamente menor no nível superior de escolaridade (12 ou mais anos de estudo), não havendo diferenças entre os demais níveis. CONCLUSÃO Alimentos ultraprocessados são consumidos com alta frequência na população brasileira adulta das 27 capitais da federação. Pertencer ao sexo masculino, ser mais jovem e ter escolaridade inferior à universitária são condições que aumentam, de forma independente, o consumo desses alimentos.

    Abstract in English:

    ABSTRACT OBJECTIVE To describe the magnitude of consumption of ultra-processed foods in the adult population (≥ 18 years old) in the capitals of the 27 federative units of Brazil, as well as its association with sociodemographic variables. METHODS Data used in this study stem from participants (n = 52,443) of the 2019 wave of the annual survey of the “National surveillance system for risk and protective factors for chronic diseases by telephone survey” (Vigitel). The consumption of ultra-processed foods was described based on a score, corresponding to the sum of positive responses to questions about consumption on the previous day of thirteen subgroups of ultra-processed foods frequently consumed in Brazil. Poisson regression models were used to describe the crude and adjusted associations between high consumption of ultra-processed foods (scores ≥ 5) and sex, age group, and level of education. RESULTS The frequency of high consumption of ultra-processed foods was 18.2% (95% CI 17.4–19.0). With or without adjustment for other sociodemographic variables, this frequency was significantly lower in females and decreased linearly with age. In the crude analysis, there was an increase in the frequency of high consumption from the lower level to the intermediate level of education and a decrease in this consumption from the intermediate level to the upper level. In the analysis adjusted for sex and age, the frequency of high consumption of ultra-processed foods was significantly lower at the higher level of education (12 or more years of study), with no differences between the other levels. CONCLUSION Ultra-processed foods are consumed with high frequency in the adult Brazilian population in the 27 capitals of the federation. Being male, younger and having less education than university are conditions that increase, independently, the consumption of these foods.
  • What, what for and how? Developing measurement instruments in epidemiology Original Article

    Reichenheim, Michael; Bastos, João Luiz

    Abstract in Portuguese:

    RESUMO Embora fundamental para a pesquisa epidemiológica, o desenvolvimento e a adaptação transcultural de instrumentos de aferição têm recebido menos destaque nas discussões metodológicas que permeiam o campo. Em paralelo, a qualidade das mensurações realizadas em muitos estudos epidemiológicos está frequentemente aquém do desejado para a construção de conhecimento sólido sobre o processo saúde-doença. A escassez de sistematizações sobre o que, para que e como aferir na área provavelmente contribui para esse cenário. Nesta revisão, propomos um modelo processual composto por uma sequência de etapas voltadas à mensuração de construtos em níveis aceitáveis de validade, confiabilidade e, por extensão, comparabilidade. Subjaz à proposta a ideia de que não apenas alguns, mas diversos estudos concatenados entre si e sucessivamente mais aprofundados devem ser conduzidos para obter aferições adequadas. A implementação do modelo poderá contribuir para alargar o interesse sobre instrumentos de aferição e, especialmente, para enfrentar os problemas investigados em epidemiologia.

    Abstract in English:

    ABSTRACT The development and cross-cultural adaptation of measurement instruments have received less attention in methodological discussions, even though it is essential for epidemiological research. At the same time, the quality of epidemiological measurements is often below ideal standards for the construction of solid knowledge on the health-disease process. The scarcity of systematizations in the field about what, what for, and how to adequately measure intangible constructs contributes to this scenario. In this review, we propose a procedural model divided into phases and stages aimed at measuring constructs at acceptable levels of validity, reliability, and comparability. Underlying our proposal is the idea that not only some but several connected studies should be conducted to obtain appropriate measurement instruments. Implementing the model may contribute to broadening the interest in measurement instruments and, especially, addressing key epidemiological problems.
  • Evolution of care during pregnancy and childbirth in the extreme south of Brazil Original Article

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

    Abstract in Portuguese:

    RESUMO OBJETIVO Descrever a evolução da assistência à gestação e ao parto entre puérperas residentes no município de Rio Grande (RS) utilizando dados de inquéritos realizados a cada três anos, entre 2007 e 2019. MÉTODOS Em até 48 horas após o parto foi aplicado questionário único, padronizado, a todas as mães que tiveram filhos nos hospitais locais e cumpriram os critérios de inclusão. Foram investigadas características demográficas e reprodutivas, hábitos de vida, nível socioeconômico da família e cuidados recebidos durante a gestação e o parto. Na análise, utilizou-se o teste qui-quadrado de tendência linear para avaliar a distribuição dos indicadores por inquérito. RESULTADOS Ao todo, 12.645 parturientes foram entrevistadas (98% do total de mulheres aptas a participar da pesquisa). No período avaliado, a proporção de partos caiu 35% entre adolescentes e aumentou 25% entre mulheres com 35 anos ou mais. As mães ganharam, em média, dois anos de escolaridade, e suas famílias tiveram importante melhora econômica, seguida, porém, de perda de renda no último inquérito. O tabagismo materno, antes e durante a gravidez, caiu à metade. Houve aumento na taxa de mães que iniciaram o pré-natal no primeiro trimestre, e aumentou também o número de consultas e de testes laboratoriais. Quase 60% das consultas de pré-natal e 80% dos partos ocorreram no Sistema Único de Saúde. Em 2019, o parto vaginal voltou a ser o mais comum. As taxas de baixo peso ao nascer (9%) e prematuridade (17%) praticamente não se modificaram. CONCLUSÕES Houve mudança importante no perfil reprodutivo e aumento da cobertura de diversos serviços de assistência pré-natal e parto. As crianças seguem nascendo bem, mas o baixo peso ao nascer e a prematuridade continuam endêmicos.

    Abstract in English:

    ABSTRACT OBJECTIVES To describe the evolution of care during pregnancy and childbirth among postpartum women living in the municipality of Rio Grande, Southern Brazil, using data from surveys carried out every three years between 2007 and 2019. METHODS Within 48 hours after delivery, a single, standardized questionnaire was applied to all mothers who had children in local hospitals and met the inclusion criteria. Demographic and reproductive characteristics, lifestyle habits, socioeconomic level of the family, and care received during pregnancy and childbirth were investigated. In the analysis, the chi-square test for linear trend was used to assess the distribution of indicators per survey. RESULTS A total of 12,645 parturients were interviewed (98% of the women eligible to participate in the surveys). In the period evaluated, the proportion of births fell 35% among adolescents and increased 25% among women aged 35 years and over. Mothers gained, on average, two years of schooling, and their families experienced an important economic improvement, followed by loss of income in the last survey. Maternal smoking, before and during pregnancy, fell by half. The rate of mothers who started prenatal care in the first trimester and the number of consultations and laboratory tests increased. Almost 60% of prenatal consultations and 80% of births took place in the Brazilian Unified Health System. In 2019, vaginal delivery was once again the most common. The rates of low birth weight (9%) and prematurity (17%) virtually remained unchanged. CONCLUSIONS We found an important change in the reproductive profile and increased coverage of various prenatal care and delivery services. Children continue to be born well, but low birth weight and prematurity remain endemic.
  • Public expenditure on hospitalizations for COVID-19 treatment in 2020, in Brazil Original Article

    Santos, Hebert Luan Pereira Campos dos; Maciel, Fernanda Beatriz Melo; Santos Junior, Geovani Moreno; Martins, Poliana Cardoso; Prado, Nília Maria de Brito Lima

    Abstract in Portuguese:

    RESUMO OBJETIVO Descrever os gastos decorrentes das internações para tratamento clínico de usuários diagnosticados com Covid-19 no Sistema Único de Saúde (SUS) entre fevereiro e dezembro de 2020. MÉTODOS Estudo descritivo, elaborado a partir de dados do Sistema de Informações Hospitalares sobre gastos governamentais com internações hospitalares para tratamento clínico de usuários diagnosticados com Covid-19 e das causas incluídas nos capítulos do CID-10. Obteve-se o número de internações, tempo médio de permanência, taxa de letalidade e os gastos totais considerando serviços hospitalares, serviços profissionais e gasto médio por internação. RESULTADOS No período avaliado, ocorreram 462.149 internações hospitalares no SUS, sendo 4,9% delas para tratamento de usuários com coronavírus. O gasto total foi superior a 2,2 bilhões de reais, sendo 85% destinados a serviços hospitalares e 15% a serviços profissionais. Os gastos para o tratamento da covid-19 se distribuíram de forma distinta entre as regiões do país. A região Sudeste teve o maior número de internações, maior valor total gasto, maior média de permanência em dias e maior taxa de letalidade, enquanto a região Sul registrou maior porcentagem de gastos com hospitais sem fins lucrativos (58%) e hospitais empresariais (15%). CONCLUSÕES As internações para tratamento clínico da infecção pelo coronavírus foram mais onerosas se comparadas às internações para tratamento de insuficiências respiratórias agudas e pneumonias ou influenza. Os resultados demonstraram as disparidades frente aos gastos de internação para procedimentos similares entre as regiões do país, evidenciando a vulnerabilidade e a necessidade de estratégias para diminuir as diferenças no acesso, uso e distribuição de recursos do SUS, garantindo equanimidade, e considerando as injustas desigualdades entre as regiões do país.

    Abstract in English:

    ABSTRACT OBJECTIVE Describe the expenditure resulting from hospitalizations for clinical treatment of users diagnosed with COVID-19 in the Unified Health System (SUS) between February and December 2020. METHODS This is a descriptive study based on data from the Hospital Information System about government expenditure on hospitalizations for clinical treatment of users diagnosed with COVID-19 and causes included in the ICD-10 chapters. We obtained the number of hospitalizations, average length of stay, lethality rate, and total expenditure considering hospital services, professional services and average expenditure per hospitalization. RESULTS In the period evaluated, SUS registered 462,149 hospitalizations, 4.9% of them for COVID-19 treatment. Total expenditure exceeded R$ 2.2 billion, with 85% allocated to hospital services and 15% to professional services. Expenditure for treating COVID-19 was distributed differently between the country’s regions. The Southeast region had the highest number of hospitalizations, highest total amount spent, highest average length of stay in days, and highest lethality rate; the South region, in turn, recorded the highest percentage of spending on non-profit hospitals (58%) and corporate hospitals (15%). CONCLUSIONS Hospitalizations for clinical treatment of coronavirus infection were more costly compared to those for treatment of acute respiratory failure and pneumonia or influenza. Our results show the disparities in hospitalization expenditure for similar procedures between the regions of Brazil, underlining the vulnerability and the need for strategies to reduce the differences in access, use, and distribution of SUS resources, ensuring equanimity, and considering the unfair inequalities between the country’s regions.
  • Two validity evidences of the ESQUADA and Brazilians’ dietary quality levels Original Article

    Santos, Thanise Sabrina Souza; Araújo, Pedro Henrique de Moura; Andrade, Dalton Francisco de; Louzada, Maria Laura da Costa; Assis, Maria Alice Altenburg de; Slater, Betzabeth

    Abstract in Portuguese:

    RESUMO OBJETIVO Avaliar duas evidências de validade da escala de qualidade da dieta (ESQUADA) para seleção dos itens com melhor discriminação da qualidade da dieta dos brasileiros e propor uma descrição em níveis de escore. MÉTODOS Adolescentes e adultos brasileiros e residentes no país (n = 2.059), responderam a um questionário on-line com 52 itens, compartilhado em redes sociais e listas de correio eletrônico entre março e abril de 2018. Foram aplicados testes estatísticos para análise de evidências de validade e confiabilidade do instrumento. A análise fatorial foi aplicada para estudo da dimensionalidade dos itens do questionário. A teoria de resposta ao item foi aplicada para identificar a discriminação e localização dos itens no continuum , construir a escala e avaliar o comportamento diferencial dos itens quanto ao sexo e idade. RESULTADOS Dentre os 52 itens do questionário, 25 apresentaram maior precisão de medida, com ajuste e confiabilidade adequados. O item sobre o costume de comer alimentos ultraprocessados em casa apresentou a melhor discriminação da qualidade da dieta. Nenhum item apresentou comportamento diferencial quanto a sexo e idade. Na construção da ESQUADA foram identificados cinco níveis de qualidade da dieta: “muito ruim”, “ruim”, “boa”, “muito boa” e “excelente”. Observou-se que enquanto cereais matinais e/ou barrinhas de cereais são consumidos com maior frequência por indivíduos com qualidade da dieta “muito ruim”; castanhas e/ou nozes são consumidos mais frequentemente por aqueles indivíduos com qualidade da dieta “excelente”. CONCLUSÕES A ESQUADA é composta por 25 itens precisos e sem comportamento diferencial para avaliar a qualidade da dieta dos brasileiros. A construção da ESQUADA possibilitou reconhecer consumo e práticas alimentares característicos de cada nível de qualidade da dieta.

    Abstract in English:

    ABSTRACT OBJECTIVE Assess two validity evidences of the diet quality scale (ESQUADA) for the selection of items with better discrimination of the Brazilians’ diet quality and propose a description in score levels. METHODS Brazilian adolescents and adults residing in the country (n = 2,059) answered an online questionnaire with 52 items, shared on social networks and email lists between March and April 2018. Statistical tests were applied to analyze the validity and reliability of the instrument’s evidence. Factor analysis was applied to study the dimensionality of the questionnaire items. Item response theory was applied to identify the discrimination and location of items on the continuum, construct the scale and assess the differential item functioning in terms of sex and age. RESULTS Among the 52 items of the questionnaire, 25 had greater measurement accuracy, with adequate adjustment and reliability. The item on the habit of eating ultra-processed foods at home showed the best discrimination of diet quality. No item showed differential functioning regarding sex and age. In the construction of the ESQUADA, five diet quality levels were identified: very poor, poor, good, very good and excellent. It was observed that while breakfast cereals and/or cereal bars are more frequently consumed by individuals with “very poor” diet quality; nuts and/or walnuts are most often consumed by those individuals with “excellent” diet quality. CONCLUSION The ESQUADA consists of 25 precise items with no differential functioning to assess the quality of Brazilians’ diet. The construction of the ESQUADA made it possible to recognize food consumption and dietary practices characteristic of each level of diet quality.
  • Prenatal care of Venezuelans in Colombia: migrants navigating the healthcare system Original Article

    Giraldo, Vanesa; Sobczyk, Rita; Fernández-Niño, Julián Alfredo; Rojas-Botero, Maylen Liseth; Bojorquez, Ietza

    Abstract in English:

    ABSTRACT OBJECTIVES To explore the experiences of irregular (undocumented) Venezuelan migrants in accessing prenatal health services in Colombia and to examine the economic, social, and cultural resources mobilized by them to gain access to care. METHODS Data was retrieved from the qualitative component of a multi-method research conducted with pregnant immigrants in Barranquilla, Colombia, between 2018 and 2019, and triangulated with a review of regulations established by the Ministry of Health and Social Protection. RESULTS Having limited economic capital, participants use social capital from personal networks and migrant organizations. They obtain cultural health capital in the form of information on the health system and use their cultural competencies to interact with this system. CONCLUSIONS FOR PRACTICE Migrants exert their agency through the use of capitals, although with certain constraints. Policies aimed at this social group should consider the strengths of migrants.
  • Food frequency questionnaire for adults in the Brazilian Northeast region: emphasis on the level of food processing Original Article

    Motta, Virginia Williane de Lima; Lima, Severina Carla Vieira Cunha; Marchioni, Dirce Maria Lobo; Lyra, Clélia de Oliveira

    Abstract in Portuguese:

    RESUMO OBJETIVO Desenvolver um Questionário de Frequência Alimentar (QFA) quantitativo para adultos da região Nordeste do Brasil, com o fim de identificar a frequência de consumo de alimentos considerados de proteção e risco para doenças crônicas não transmissíveis (DCNT), agrupando os itens alimentares por nível de processamento. MÉTODOS Para desenvolver o QFA foram utilizados dados de 7.516 adultos do Nordeste do Brasil, extraídos da Pesquisa de Orçamentos Familiares 2008–2009. As listas de alimentos foram elaboradas segundo a metodologia da contribuição relativa do item, nas quais foram identificados os itens alimentares com maior contribuição relativa para macronutrientes, fibra, gordura saturada, gordura trans, sódio e potássio. Tais listas foram compostas de todos os alimentos cujo somatório de contribuição foi de até 90%. Na estrutura final do QFA, os itens alimentares foram organizados de modo a respeitar a imagem mental das refeições. RESULTADOS O QFA resultou em 83 itens alimentares, distribuídos em minimamente processados, processados e ultraprocessados. O ano anterior foi escolhido como tempo para estimar o consumo dos alimentos, e as opções de frequência variaram de “nunca” até “10 vezes”. O instrumento inclui orientações para preenchimento e colhe dados sobre o tamanho das porções (pequena, média, grande e extragrande), bem como informações complementares sobre as preparações culinárias. Registrou-se um percentual elevado de pessoas com excesso de peso (44,1%). CONCLUSÃO O estudo culminou em um QFA para identificar a frequência de consumo de alimentos considerados de proteção e risco para DCNT. O instrumento pode subsidiar estudos epidemiológicos que avaliem desfechos relacionados à dieta de adultos considerando o nível de processamento de alimentos, em consonância com o Guia alimentar para a população brasileira .

    Abstract in English:

    ABSTRACT OBJECTIVE To develop a quantitative Food Frequency Questionnaire (FFQ) for adults in the Northeast region of Brazil, in order to identify the frequency of consumption of foods considered to be of protection and risk for chronic non-communicable diseases (NCDs), grouping food items by processing level. METHODS To develop the FFQ, data from 7,516 adults from Northeastern Brazil were used, extracted from the 2008–2009 Household Budget Survey. The food lists were elaborated according to the methodology of the relative contribution of each item, identifying foods with the highest relative contribution for macronutrients, fiber, saturated fat, trans fat, sodium and potassium. All foods whose contribution sum was up to 90% composed such lists. The final structure of the FFQ organized the food items in order to respect the mental image of the meals. RESULT The FFQ resulted in 83 food items, distributed in minimally processed, processed and ultra-processed. We chose the previous year as the time to estimate food consumption, and frequency options ranged from “never” to “10 times”. The instrument includes guidelines for filling and collects data on serving sizes (small, medium, large and extra-large), as well as additional information on culinary preparations. There was a high percentage of people who were overweight (44.1%). CONCLUSION The study culminated in an FFQ to identify the frequency of consumption of foods considered protective and risk for NCDs. The instrument can support epidemiological studies that evaluate outcomes related to the diet of adults considering the level of food processing, in accordance with the Guia alimentar para a população brasileira .
  • Dietary patterns in Mexican preschool children are associated with stunting and overweight Original Article

    Flores, Mario E.; Rivera-Pasquel, Marta; Macías, Nayeli; Sánchez-Zamorano, Luisa María; Rodríguez-Ramírez, Sonia; Contreras-Manzano, Alejandra; Denova-Gutiérrez, Edgar

    Abstract in English:

    ABSTRACT OBJECTIVE To evaluate the association between dietary patterns, stunting, and overweight among Mexican preschoolers. METHODS This study was conducted with anthropometric (weight, height/length), sociodemographic (age, gender, education level of household head, socioeconomic status, country region and area, ethnicity, and beneficiary of social programs), and dietary data (Semiquantitative-food frequency questionnaire) on children aged from 1 to 4 years collected from the Mexican National Health and Nutrition Survey-2012. Dietary patterns were derived by principal components analysis. The association between dietary patterns, stunting, and overweight was assessed by prevalence ratios (PR), estimated by Poisson regression. RESULTS In total, 1,112 preschoolers (mean age 3.06 years, SD = 1.08 years; 48.8% females) were included in the study; 11.9% of whom presented stunting, and 6.7% overweight. We identified four dietary patterns: Fruits and Vegetables [F&V], Western [W], Traditional [T], and Milk and Liquids [M&L]. Considering the lowest tertile of each dietary pattern as reference, the prevalence of stunting was 2.04 times higher [95%CI: 1.17–3.56] among children in the highest tertile of the “F&V” pattern. The prevalence of stunting was lower among children in the highest tertile of the “W” pattern [PR = 0.48; 95%CI: 0.27–0.85]. Overweight was negatively associated with the “F&V” dietary pattern [PR = 0.37; 95%CI: 0.16–0.85 for its highest tertile], and children whose consumption was mostly equivalent to the “T” pattern showed higher prevalence of stunting [PR = 1.74; 95%CI: 1.01–3.00]. CONCLUSIONS The prevalence of stunting and overweight in a nationwide sample of Mexican preschoolers was associated with dietary patterns.
  • Safety culture in the perception of public-hospital health professionals Original Article

    Carvalho, Paloma Aparecida; Amorim, Fábio Ferreira; Casulari, Luiz Augusto; Gottems, Leila Bernarda Donato

    Abstract in Portuguese:

    RESUMO OBJETIVO Avaliar a cultura de segurança na percepção dos profissionais que trabalham nos hospitais públicos do Sistema Único de Saúde (SUS) do Distrito Federal, Brasil, três anos após a implantação do Programa Nacional de Segurança do Paciente (PNSP). MÉTODOS estudo transversal analítico realizado em onze hospitais públicos por meio do Safety Attitudes Questionnaire em formato eletrônico. A amostragem estratificada foi calculada, obedecendo à proporção do total de profissionais em cada hospital, assim como a representatividade de cada grupo profissional. Os resultados do escore total e dos domínios iguais ou maiores que 75 foram considerados positivos. Realizadas análises descritivas e inferenciais dos grupos profissionais e dos hospitais. RESULTADOS Participaram 909 profissionais. O escore total por grupo profissional foi negativo (62,5 a 69,5) e por domínio diferiram estatisticamente entre si em todos. Os onze hospitais tiveram escore total negativo (61,5 a 68,6). Os domínios com desempenho positivo foram satisfação no trabalho, percepção do estresse e clima de trabalho em equipe. Os resultados mais baixos foram condições de trabalho e percepção da gerência, e nenhum dos hospitais obteve média superior à 75 nesses domínios. Também foram encontradas diferenças nas médias dos domínios entre os hospitais, exceto em percepção da gerência. DISCUSSÃO Após três anos de implantação no PNSP, a cultura de segurança nos onze hospitais avaliados se mostrou fragilizada, embora os domínios satisfação no trabalho, percepção do estresse e clima de trabalho em equipe tiveram resultados positivos. Os resultados podem contribuir para a tomada de decisão dos gestores, pois a cultura de segurança é um elemento essencial na implementação da política de segurança do paciente.

    Abstract in English:

    ABSTRACT OBJECTIVE Evaluating safety culture in the perception of professionals working in public hospitals of the Unified Health System (SUS) of Distrito Federal, Brazil, three years after the implementation of the National Patient Safety Program (PNSP). METHODS Analytical cross-sectional study conducted in eleven public hospitals using the Safety Attitudes Questionnaire (SAQ) in electronic format. Stratified sampling was estimated according to the proportion of the total number of professionals in each hospital, as well as the representativeness of each professional group. The results of the total score and domains equal to or greater than 75 were considered positive. Descriptive and inferential analyses of professional groups and hospitals were carried out. RESULTS 909 professionals participated. The total score by professional group was negative (62.5 to 69.5) and the domains differed statistically in all cases. The eleven hospitals had a negative total score (61.5 to 68.6). The domains to attain positive performance were job satisfaction, stress recognition and teamwork climate. The lowest results were in working conditions and management perception domains, for which none of the hospitals had an average above 75. Differences were also found for domain means across hospitals, except in management perception. DISCUSSION Three years after the implementation of PNSP, the safety culture in eleven hospitals evaluated was weak, although the domains of job satisfaction, stress recognition and teamwork climate had positive results. The results can contribute to decision-making by managers, as safety culture is an essential element in the implementation of patient safety policy.
  • Construction and validation of a logical model for specialized Rehabilitation Centers Original Article

    Valentim, Regis de Souza; Dantas, Thaissa Hamana de Macedo; Machado, Flavia Christiane de Azevedo; Araújo, Camilla Medeiros; Silva, Marilene Soares da; Castaneda, Luciana; Dantas, Diego

    Abstract in Portuguese:

    RESUMO OBJETIVO Construir e validar um modelo lógico para a atenção nos Centros Especializados em Reabilitação (CER) a partir da análise do processo de trabalho e de questões organizativas de centros do Rio Grande do Norte. MÉTODOS Estudo metodológico desenvolvido em três etapas: 1) estudo documental de legislações e portarias relacionadas ao serviço de saúde e à Rede de Cuidados à Pessoa com Deficiência (RCPD); 2) realização de grupos focais, com estudo censitário dos CER do Rio Grande do Norte, para compreender e avaliar o cotidiano do serviço; e 3) sistematização das informações coletadas e, por fim, proposição e validação do modelo lógico avaliativo. RESULTADOS O modelo englobou cinco categorias centrais do processo de trabalho e organizacional: “demandas”, “recursos” (insumos, financeiros e força de trabalho), “processos”, “produtos e resultados” e “missão, valores e fatores externos”. CONCLUSÃO O modelo lógico construído foi adequado para representação gráfica do processo de trabalho e questões organizativas dos CER. Evidenciou-se que o funcionamento dos serviços está alinhado com as normativas. Contudo, ainda há lacunas organizacionais que precisam ser abordadas a fim de melhorar a resolutividade do serviço e a articulação com outros pontos da rede.

    Abstract in English:

    ABSTRACT OBJECTIVE To build and validate a logical model for health care in Specialized Rehabilitation Centers (CER) by analyzing the work process and organizational issues of centers in Rio Grande do Norte. METHODS This is a methodological study developed in three stages: 1) documentary research of legislation and ordinances concerning the healthcare service and the Disability Care Network (RCPD); 2) focus groups with a Census study of the CER in Rio Grande do Norte to understand and assess the daily activities of the service; and 3) systematization of the information collected and, finally, proposition and validation of the evaluative logical model. RESULTS The model encompassed five central categories of the work and organizational process: “demands”, “resources” (inputs, financial and workforce), “processes”, “products and results” and “mission, values and external factors”. CONCLUSION The logical model built was suitable for graphical representation of the work process and organizational issues of the SRC. The study showed that the functioning of the services is in line with the regulations. However, there are still organizational gaps that need to be addressed to improve the resolution capacity of the service and the articulation with other points of the network.
  • Prevalence evolution of SARS-CoV-2 infection in the city of São Paulo, 2020–2021 Original Article

    Albuquerque, José Olimpio Moura de; Kamioka, Gabriela Akemi; Madalosso, Geraldine; Costa, Selma Anequini; Ferreira, Paula Bisordi; Pino, Francisco Alberto; Sato, Ana Paula Sayuri; Carvalho, Ana Carolina Aguiar de; Amorim, Ana Beatriz Pagliaro; Aires, Caroline Cotrim; Kataoka, Ana Paula Arruda Geraldes; Savani, Elisa San Martin Mouriz; Bessa, Thirsa Alvares Franco; Aguiar, Breno Souza de; Failla, Marcelo Antunes; Santos, Edson Aparecido dos; Brito, Edjane Maria Torreão; Santos, Maria Cristina Honório dos; Silva, Solange Maria Saboia e; Caldeira, Luiz Artur Vieira; Zamarco, Luiz Carlos; Fonseca, Sandra Maria Sabino; Lima, Marcia Maria de Cerqueira; Marques, Ivanilda Argenau; Silva, Fabiana Érica Vilanova da; Glasser, Paula Regina; Burihan, Patrícia Carla Piragibe Ramos; Cavazzana, Cinthya Luzia; Mello, Debora Silva de; Pellini, Alessandra Cristina Guedes; Nishio, Fernando Yoshiki; Kian, Fernanda Miyashiro; Braga, Elza de Santana; Bertelli, Nilza Maria Piassi; Fracini, Wagner; Gonçalves, Marcelo Dell Áquila; Zular, Paulete Secco; Piva, Regiane de Santana; Masi, Eduardo

    Abstract in English:

    ABSTRACT OBJECTIVE To estimate the evolution of the prevalence of SARS-CoV-2 virus infection among residents aged 18 years or over in the municipality of São Paulo. METHODS This is a population-based household survey conducted every 15 days, between June and September 2020, and January and February 2021. In total, the study comprised 11 phases. The presence of antibodies against SARS-CoV-2 was identified in venous blood using a lateral flow test, Wondfo Biotech. In the last phase, the researchers combined it with an immunoenzymatic test, Euroimmun. The participants also answered a semi-structured questionnaire on sociodemographic and economic factors, and on social distancing measures. Prevalence estimates and the 95% confidence interval were estimated according to regions, Human Development Index, sex, age group, ethnicity, education, income, and variables associated with risk or prevention of infection. To compare the frequencies among the categories of each variable, the chi-square test with Rao-Scott correction was used, considering a significance level of 5%. RESULTS In total, 23,397 individuals were interviewed and had their samples collected. The estimated prevalence of antibodies against SARS-CoV-2 ranged from 9.7% (95%CI: 7.9–11.8%) to 25.0% (95%CI: 21.7–28.7). The prevalence of individuals with antibodies against the virus was higher among black and brown people, people with lower schooling and income, and among residents of regions with lower Human Development Index. The lowest prevalences were associated with recommended measures of disease protection. The proportion of asymptomatic infection was 45.1%. CONCLUSION The estimated prevalence of the infection was lower than the cumulative incidence variation, except for the last phase of the study. The differences in prevalence estimates observed among subpopulations showed social inequality as a risk of infection. The lower prevalence observed among those who could follow prevention measures reinforce the need to maintain social distancing measures as a way to prevent SARS-CoV-2 infection.
  • Adverse events following immunization against SARS-CoV-2 (covid-19) in the state of Minas Gerais Original Article

    Silva, Roberta Barros da; Silva, Thales Philipe Rodrigues da; Sato, Ana Paula Sayuri; Lana, Francisco Carlos Felix; Gusmão, Josianne Dias; Souza, Janaina Fonseca Almeida; Matozinhos, Fernanda Penido

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar os eventos adversos pós-vacinação (EAPV) contra o SARS-CoV-2 (covid-19) no estado de Minas Gerais (MG). MÉTODOS Estudo epidemiológico, descritivo, com dados do e-SUS Notifica no estado de Minas Gerais durante o período de 20 de janeiro a 5 de março de 2021. Foram analisados todos os casos suspeitos de EAPV da vacina contra covid-19 no estado, totalizando 7.305 casos. Para este estudo, verificou-se a possível correlação entre os EAPV e a causalidade com o imunobiológico administrado no período estabelecido. As variáveis analisadas para os casos de EAPV foram o imunobiológico administrado (AstraZeneca ou Coronavac), o tipo de evento, a evolução do caso e o tempo em dias da administração do imunobiológico e o início dos sintomas e causalidade. Calculou-se a taxa de incidência (TI) para 100 mil doses aplicadas. RESULTADOS A ocorrência dos EAPV em decorrência da vacina contra covid-19 foi frequente (TI: 777,12) no estado. Entretanto, somente 3% foram classificados como EAPV grave, com TI de 20,85, sendo que 4,71% deles evoluíram para óbitos com TI (8,19 óbitos a cada 100 mil doses aplicadas). Dentre os óbitos analisados, 84,4% foram classificados como condições preexistentes causadas por outros fatores e não por vacinas. Em relação aos EAPV não graves, 1,11% foram em decorrência de erros de imunização (TI: 8,62 EI a cada 100 mil doses aplicadas). CONCLUSÃO Esse trabalho fomenta, portanto, a discussão sobre a importância dos registros dos EAPV decorrentes das vacinas contra covid-19, demonstrando sua segurança para a população.

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze adverse events following immunization (AEFI) against SARS-CoV-2 (covid-19) in the state of Minas Gerais (MG), Brazil. METHODS Epidemiological, descriptive study, with data from e-SUS Notifica (e-SUS Notification) in the state of Minas Gerais from January 20 to March 5, 2021. All suspected cases of AEFI of the covid-19 vaccine in the state were analyzed, totaling 7,305 cases. In this study, we verified the possible correlation between AEFI and the possible immunobiological administered causalities. The variables analyzed for AEFI cases were the immunobiological agent administered (AstraZeneca or Coronavac), the type of event, the evolution of the case, and the time in days since the administration of the immunobiological agent and the onset of symptoms and causality. The incidence rate (IT) was calculated for 100,000 doses applied. RESULTS The occurrence of AEFI as a result of the covid-19 vaccine was frequent (TI: 777.12) in the state. However, only 3% were classified as a severe AEFI, with a 20.85 IT, and 4.71% of them evolved to deaths (8.19 deaths per 100,000 doses applied). Among the deaths analyzed, 84.4% were classified as preexisting conditions caused by factors other than vaccines. Regarding non-serious AEFI, 1.11% occurred by immunization errors (TI: 8.62 EI for every 100 thousand doses applied). CONCLUSION This work encourages the discussion about the importance of recording AEFI related to covid-19 vaccines, demonstrating its safety for the population.
  • Physical activity in gestational trimesters and perinatal outcomes in SUS puerperal women Original Article

    Schmidt, Tauana Prestes; Tuon, Talita; Wagner, Katia J. Pudla; Boing, Antonio Fernando; Danielewicz, Ana Lúcia

    Abstract in Portuguese:

    RESUMO OBJETIVO Testar a associação entre a prática de atividade física (AF) de acordo com os trimestres gestacionais e a ocorrência de parto cesáreo, prematuridade e baixo peso ao nascer em puérperas atendidas no Sistema Único de Saúde de Santa Catarina, Brasil. MÉTODOS Estudo transversal realizado com amostra probabilística de puérperas que tiveram seus partos em maternidades da rede pública de Santa Catarina no período de janeiro a agosto de 2019. O desfecho parto cesáreo foi autorreferido e as informações sobre parto prematuro (< 37 semanas gestacionais) e baixo peso ao nascer (< 2.500 gramas) foram obtidas dos prontuários. A prática de AF durante a gestação e conforme cada trimestre foi autorreferida. Foram realizadas análises de Regressão Logística Multivariável e entrevistas com 3.580 puérperas. RESULTADOS A prática de AF durante qualquer período da gestação foi relatada por 20,6% da amostra, com redução gradativa das prevalências conforme os trimestres gestacionais (16,2%, 15,4% e 12,8%). As maiores prevalências dos desfechos em relação à amostra total, foram observadas nas puérperas não praticantes de AF no terceiro trimestre, sendo 43,9% para o parto cesáreo, 7,7% para o baixo peso ao nascer e 5,5% para o parto prematuro. As chances de parto cesáreo (OR = 1,40; IC95% 1,10–1,76) e de baixo peso ao nascer (OR = 1,99; IC95% 1,04–3,79) foram, respectivamente, 40% e 99% maiores entre as puérperas que não praticaram AF no terceiro trimestre da gestação quando comparadas àquelas que praticaram AF. Não houve associação da prática de AF com a prematuridade. CONCLUSÃO As puérperas que não praticavam AF no terceiro trimestre da gestação tiveram maiores chances de parto cesáreo e de terem recém-nascidos com baixo peso.

    Abstract in English:

    ABSTRACT OBJECTIVE Test the association between the practice of physical activity (PA) according to the gestational trimesters and the occurrence of cesarean delivery, prematurity, and low birth weight in puerperal women assisted in the Unified Health System of Santa Catarina, Brazil. METHODS A cross-sectional study was conducted with a probabilistic sample of puerperal women who gave birth in public maternity hospitals in Santa Catarina from January to August 2019. The cesarean delivery outcome was self-reported, and information on premature birth (< 37 gestational weeks) and low birth weight (< 2,500 grams) were obtained from medical records. The practice of PA during pregnancy and according to each trimester was self-reported. Multivariate Logistic Regression analyses and interviews with 3,580 puerperal women were carried out. RESULTS PA practice during any period of pregnancy was reported by 20.6% of the sample, with a gradual reduction in prevalence according to the gestational trimester (16.2%, 15.4%, and 12.8%). The highest prevalences of outcomes concerning the total sample were observed in puerperal women who did not practice PA in the third trimester, with 43.9% for cesarean delivery, 7.7% for low birth weight, and 5.5% for premature birth. The odds of cesarean delivery (OR = 1.40; 95%CI 1.10–1.76) and low birth weight (OR = 1.99; 95%CI 1.04–3.79) were, respectively, 40% and 99% higher among puerperal women who did not practice PA in the third trimester of pregnancy when compared to those who practiced PA. There was no association between PA practice and prematurity. CONCLUSION Puerperal women who did not practice PA in the third trimester of pregnancy were more likely to have cesarean delivery and low birth weight newborns.
  • Physical activity combined with sedentary behaviour in the risk of mortality in older adults Original Article

    Galvão, Lucas Lima; Silva, Rizia Rocha; Tribess, Sheilla; Santos, Douglas Assis Teles; Virtuoso Junior, Jair Sindra

    Abstract in English:

    ABSTRACT OBJECTIVE To examine the effects of physical activity (PA) and sedentary behaviour (SB), in isolation and combination, on all-cause mortality in older adults. METHODS Prospective, population-based cohort study. The data were collected from first wave in 2015 and the follow-up continued until 2020. The sample consisted of 332 older adult people aged ≥ 60 years-old, out of which 59 died. The level of PA and SB was assessed by the International Physical Activity Questionnaire (IPAQ). The older adults were divided into PA categorized as sufficiently active and insufficiently active and into high and low SB. We built four combinations of PA and SB. Also, we used the Cox proportional hazards regression with a 95% confidence interval with hazard ratio estimate so as to verify the mortality risks between PA, SB, and the combinations of PA and SB. RESULTS Insufficiently active individuals had higher risks of mortality compared to sufficiently active people. We observed no associations between SB and mortality separately; however, when evaluated in a combined way, insufficiently active individuals and with a high SB time had a higher chance of mortality compared to active individuals with a low SB time. CONCLUSION Our isolated analyses demonstrate that complying with PA recommendations reduces the risk of mortality; however, no association was found between the time of PA exposure with the time of SB. When analysing the combination, being physically inactive and with a long time of SB showed higher mortality rates, with SB being an enhancer of this risk. The results of this study show the interdependence of SB for PA performed at moderate to vigorous intensity. The understanding of this interrelation must be considered in the formulation of public health guidelines.
  • Feeding practices and early weaning in the neonatal period: a cohort study Original Article

    Pinheiro, Josilene Maria Ferreira; Flor, Taiana Brito Menêzes; Araújo, Mayara Gabrielly Germano de; Xavier, Ana Márcia Soares Fernandes; Mata, Amanda Michelly Braga da; Pires, Vanessa Cristina da Costa; Oliveira, Luana Isabelly Carneiro de; Andrade, Fábia Barbosa de

    Abstract in English:

    ABSTRACT OBJECTIVE To describe feeding practices and the risk factors for the mixed breastfeeding and early weaning in the neonatal period. METHODS Cohort study, which we collected socioeconomic, demographic, health care and feeding data from 415 mother/child binomials born in four public maternity hospitals in Natal/Brazil. They were followed-up at 48 hours, 7 and 28 days after birth. The association was established using Pearson’s Chi-square test and Poisson’s regression, after adjusting it to other variables. RESULTS The prevalence of mixed breastfeeding in the first 2 days was 47,2% and early weaning in 7 and 28 days was 8,4% and 16,2% in that order. The main reasons for mixed breastfeeding and early weaning were: colostrum deficiency (33.8%), difficulty in latching/sucking (23.5%) and “little milk” (70.0%). The use of formula/milk/porridge remained associated with maternal age ≤ 20 years (RR = 0.64; 95%CI: 0.47–0.86), age 20–29 years (RR = 0,70; 95%CI: 0,57–0,87), primiparity (RR = 1.37; 95%CI: 1.11–1.60) and cesarean delivery (RR = 1.20; 95%CI: 1.00–1.45) at 2 days; absence of paternal support (RR = 4.98; 95%CI: 2.54–9.79) and pacifier use (RR = 3.21; 95%CI: 1.63–6.32) at 7 days; and only pacifier use (RR = 2.48; 95%CI: 1.53–4.02) at 28 days. CONCLUSIONS Early weaning was associated with maternal and health care factors, thus suggesting the need to readjust good practices and educational actions to achieve the exclusive offer to the maternal breast in the neonatal period.
  • Vaccination coverage against human papillomavirus (HPV) and associated factors in female academics from a university in southwestern Goiás, Brazil Original Article

    Oliveira, Paulo Sérgio de; Gonçalves, Carla Vitola; Watte, Guilherme; Costa, Juvenal Soares Dias da

    Abstract in Portuguese:

    RESUMO OBJETIVO Verificar a cobertura da vacina contra o HPV em mulheres matriculadas em cursos da área de saúde de uma universidade do sudoeste do Estado de Goiás e os fatores associados à vacinação. MÉTODOS Trata-se de estudo transversal, incluindo universitárias dos cursos da área de saúde, com 18 anos ou mais. Foi utilizado questionário padronizado e autoaplicável. As participantes que receberam duas ou mais doses da vacina foram consideradas como imunizadas. A análise múltipla foi realizada por meio de regressão logística multinomial. RESULTADOS Observou-se que, das 1510 participantes, 473 (31,3%) com duas ou mais doses de vacina contra o HPV, 167 (11,0%) com uma dose e 870 (57,6%) não vacinadas. As participantes com menos de 21 anos e inseridas no estrato socioeconômico A tinham 2 vezes mais chance de terem recebido duas doses ou mais da vacina (Razão de Prevalência = 1,95; IC95% 1,40–2,70 e Razão de Prevalência = 2,09; IC95% 1.39–3,13, respectivamente). CONCLUSÕES A pesquisa revelou extensa possibilidade para intervenções com o objetivo de atingir maior cobertura vacinal entre as universitárias. Mesmo mulheres com mais conhecimento e de estrato econômico elevado apresentaram baixa cobertura vacinal, sugerindo que resultados de cobertura vacinal maior podem ser obtidos com a vacinação realizada em ambiente escolar.

    Abstract in English:

    ABSTRACT OBJECTIVE To check the coverage of the HPV vaccine in women enrolled in health courses at a university in southwest Goiás, Brazil, and the factors associated with vaccination. METHODS This is a cross-sectional study, including female university students of health courses, aged 18 years or more. A standardized and self-applying questionnaire was used. Participants who received two or more doses of the vaccine were considered immunized. Multiple analysis was performed using multinomial logistic regression. RESULT We observed that, of the 1510 participants, 473 (31.3%) had two or more doses of HPV vaccine, 167 (11.0%) one dose and 870 (57.6%) were unvaccinated. Participants under 21 years of age and in socioeconomic stratum A were 2 times more likely to have received two or more doses of the vaccine (Prevalence Ratio = 1.95; 95%CI 1.40–2.70 and Prevalence Ratio = 2.09; 95%CI 1.39–3.13, respectively). CONCLUSIONS The research revealed extensive possibility for interventions with the aim of achieving greater vaccination coverage among female university students. Even women with more knowledge and high economic stratum showed low vaccination coverage, suggesting that results of higher vaccine coverage can be obtained with vaccination carried out in a school environment.
  • Cross-cultural adaptation and psychometric properties of the short version of COPSOQ II-Brazil Original Article

    Gonçalves, Josiane Sotrate; Moriguchi, Cristiane Shinohara; Chaves, Thaís Cristina; Sato, Tatiana de Oliveira

    Abstract in English:

    ABSTRACT OBJECTIVES Translate and culturally adapt the short version of Copenhagen Psychosocial Questionnaire II (COPSOQ II) into Brazilian Portuguese (COPSOQ II-Br) and evaluate its psychometric properties. METHODS Translation and cultural adaptation followed the standardized guidelines. Structural validity was assessed using exploratory factorial analysis. Test-retest reliability was evaluated by intraclass correlation coefficient (ICC3,1) and internal consistency by Cronbach’s alpha. Floor and ceiling effect was considered acceptable if less than 15% of participants reported the lowest or highest scores. Measurement error was assessed by standard error of measurement (SEM), while construct validity was tested by correlating the COPSOQ II-Br, the Job Content Questionnaire and the Nordic Musculoskeletal Questionnaire. RESULTS The study evaluated a total of 211 civil servants and service providers in the test and 157 in the retest. After cross-cultural adaptation, the COPSOQ II-Br structure comprised seven domains and 11 dimensions. Most dimensions showed acceptable floor and ceiling effects, excepting “Work family conflicts” (floor effect of 26.1%), and “Meaning and commitment” and “Job satisfaction,” with ceiling floor of 27.5% and 22.3%, respectively. Cronbach’s alpha values reached the recommended levels (varied between 0.70 and 0.87). Test-retest reliability indicated that all dimensions had ICC between 0.71 and 0.81. SEM ranged from 0.6 to 2.2 and the construct validity showed good results with the tested instruments (significant positive and negative correlations). CONCLUSIONS All psychometric properties of the short version COPSOQ II-Br are suitable for use in Brazil. The instrument is thus validated and can be used by occupational health and human resources professionals to evaluate psychosocial working conditions.
  • Scientific sexism: the gender bias in the scientific production of the Universidade de São Paulo Original Article

    Oliveira-Ciabati, Livia; Santos, Luciane Loures; Hsiou, Annie Schmaltz; Sasso, Ariane Morassi; Castro, Margaret; Souza, João Paulo

    Abstract in Portuguese:

    RESUMO OBJETIVO Investigar desigualdades de gênero na produção científica de docentes da Universidade de São Paulo. MÉTODOS A população consiste em professores(as) da Universidade de São Paulo. O repositório Web of Science foi a fonte das métricas de publicação. Selecionamos as medidas: total de publicações e citações, média de citações por ano e por item, índice H e histórico de citações entre 1950 e 2019. Usamos o nome do(a) docente como um proxy para a identidade de gênero. Usamos estatísticas descritivas para caracterizar as métricas. Avaliamos o efeito tesoura selecionando os(as) professores(as) com índice H alto. A série histórica de citações foi projetada até 2100. Realizamos análises para a população geral e subgrupos de tempo de trabalho: menos de 10 anos, de 10 a 20 anos e 20 anos ou mais. RESULTADOS Dos 8.325 docentes, incluímos 3.067 (36,8%). Dentre os incluídos, 1.893 (61,7%) eram professores e 1.174 (38,28%) professoras. O gênero masculino apresentou valores mais altos nas métricas de publicação (média de artigos: M = 67,0 versus F = 49,7; média de citações/ano: M = 53,9 versus F = 35,9) e índice H (M = 14,5 versus F = 12,4). Entre os 100 indivíduos com maior índice H (≥ 37), 83% são do gênero masculino. Na série histórica de citações, a curva masculina cresce mais rápido, abrindo uma diferença entre os grupos com afastamento confirmado pela projeção. DISCUSSÃO A produção científica na Universidade de São Paulo está sujeita a um viés de gênero. Dois terços do corpo docente são do gênero masculino, e as contratações das últimas décadas perpetuam esse padrão. A grande maioria dos membros com alto impacto no corpo docente é do sexo masculino. CONCLUSÃO Nossas análises sugerem que a Universidade de São Paulo não superará a desigualdade de gênero na produção científica sem uma ação afirmativa substancial. O desenvolvimento não acontece por acaso, mas por meio de escolhas afirmativas, decisivas e de longo prazo.

    Abstract in English:

    ABSTRACT OBJECTIVE To investigate gender inequity in the scientific production of the University of Sao Paulo. METHODS Members of the University of Sao Paulo faculty are the study population. The Web of Science repository was the source of the publication metrics. We selected the measures: total publications and citations, average of citations per year and item, H-index, and history of citations between 1950 and 2019. We used the name of the faculty member as a proxy to the gender identity. We use descriptive statistics to characterize the metrics. We evaluated the scissors effect by selecting faculty members with a high H-index. The historical series of citations was projected until 2100. We carry out analyses for the general population and working time subgroups: less than 10 years, 10 to 20 years, and 20 years or more. RESULTS Of the 8,325 faculty members, we included 3,067 (36.8%). Among those included, 1,893 (61.7%) were male and 1,174 (38.28%) female. The male gender presented higher values in the publication metrics (average of articles: M = 67.0 versus F = 49.7; average of citations/year: M = 53.9 versus F = 35.9), and H-index (M = 14.5 versus F = 12.4). Among the 100 individuals with the highest H-index (≥ 37), 83% are male. The male curve grows faster in the historical series of citations, opening a difference between the groups whose separation is confirmed by the projection. DISCUSSION Scientific production at the Universidade de São Paulo is subject to a gender bias. Two-thirds of the faculty are male, and hiring over the past few decades perpetuates this pattern. The large majority of high impact faculty members are male. CONCLUSION Our analysis suggests that the Universidade de São Paulo will not overcome gender inequality in scientific production without substantive affirmative action. Development does not happen by chance but through choices that are affirmative, decisive, and long-term oriented.
  • Mortality from diabetes mellitus and its impact on life expectancy at 60 years of age in Mexico Original Article

    Vega-López, María Guadalupe; González-Pérez, Guillermo Julián

    Abstract in Spanish:

    RESUMEN OBJETIVOS Analizar el comportamiento de la mortalidad por diabetes mellitus (DM) para ambos sexos en México entre 1998 y 2018 y su impacto sobre la esperanza de vida (EV) entre los 60 y 85 años de edad en los trienios 1998–2000 y 2016–2018 – en comparación con otras causas de muerte –, así como determinar la pérdida de años de esperanza de vida asociados a la DM en cada trienio. MÉTODOS El presente estudio es observacional y descriptivo. Se calcularon tasas de mortalidad por DM ajustadas por edad para cada sexo entre 1998 y 2018. Se construyeron tablas de vida por sexo para 1998–2000 y 2016–2018 y se calculó tanto la EV entre 60 y 85 años, como los años de esperanza de vida perdidos (AEVP) por DM, y causas seleccionadas, entre ambas edades. RESULTADOS Entre 1998 y 2018 la tasa ajustada de mortalidad masculina por DM creció 55% en la población de 60 y más, y la femenina 20%. Entre 1998–2000 y 2016–2018, la EV masculina entre 60 y 85 años se redujo 0,22 años, en tanto la femenina aumentó 0,24. En 2016–2018 la DM fue responsable, para los hombres, de 1,30 AEVP entre 60 y 85 años, (19% del total de AEVP) y para las mujeres 1,24 AEVP (24% del total), más que el resto de causas analizadas. CONCLUSIONES El incremento de la mortalidad por DM ha contribuido de manera sustancial tanto a reducir la EV de los hombres adultos mayores, como a ralentizar el aumento de la EV de las mujeres de 60 años y más en lo que va de siglo. Así, resulta necesario implementar políticas preventivas desde edades tempranas que permitan reducir los altos niveles de sobrepeso y obesidad existentes en el país, y por ende, la notable proporción de población que padece DM.

    Abstract in English:

    ABSTRACT OBJECTIVES To analyze the behavior of mortality from diabetes mellitus (DM) for both sexes in Mexico from 1998 to 2018, and its impact on life expectancy (LE) from 60 to 85 years of age in the three-year periods 1998–2000 and 2016–2018, compared with other causes of death, as well as to determine the loss of years of life expectancy associated with DM in each three-year period. METHODS The current study is observational and descriptive. Age-adjusted rates of mortality from DM were calculated for each sex from 1998 to 2018. Sex-specific life tables were constructed for 1998–2000 and 2016–2018, and both LE between 60 and 85 years, and years of life expectancy lost (YLELL) due to DM and selected causes between both ages were calculated. RESULTS Between 1998 and 2018, the adjusted DM-resulting male mortality rate grew 55% in the population aged 60 and over, while the female mortality rate grew 20%. Between 1998–2000 and 2016–2018, male LE for 60–85 age group decreased 0.22 years, while female LE increased 0.24. In 2016-2018, DM was responsible for 1.30 YLEL among men of 60 to 85 years (19% of the total YLEL), and 1.24 YLEL for women (24% of the total), more than the other causes analyzed. CONCLUSIONS The increase in mortality from DM has substantially contributed both to reduce LE of older adult men, and to slow the increase of LE among women aged 60 years and older so far this century. Thus, preventive policies should be implemented since early ages to reduce the high levels of overweight and obesity in the country and, therefore, the significant population ratio suffering from DM.
  • Incidence and mortality from breast and cervical cancer in a Brazilian town Original Article

    Ferreira, Maria do Carmo; Vale, Diama Bhadra; Barros, Marilisa Berti de Azevedo

    Abstract in Portuguese:

    RESUMO OBJETIVOS Analisar a magnitude das mudanças na incidência e mortalidade por câncer do colo do útero (CCU) e câncer de mama (CM) em Campinas (SP) entre os quinquênios 1991–1995 e 2010–2014. MÉTODOS Os dados sobre câncer foram obtidos do Registro de Câncer de Base Populacional de Campinas e os dados sobre óbitos do Sistema de Informação de Mortalidade do Departamento de Informática do Sistema Único de Saúde. Foram calculadas taxas de incidência e de mortalidade padronizadas por idade pelo método direto, com os respectivos intervalos de confiança de 95%. Mensurou-se a magnitude das mudanças por meio da razão de taxas (RT). RESULTADOS Entre os períodos estudados, houve aumento de três vezes na taxa de detecção do CCU in situ (RT = 3,03; IC95% 2,64–3,47) e de 5 vezes para o CM in situ (RT = 5,23; IC95% 4,98–5,50). A proporção de casos de CM in situ em relação ao total de casos de CM aumentou de 3,31% para 11,05%. A taxa de incidência do CCU invasivo declinou em 57% (RT = 0,43; IC95% 0,40–0,47), e a do CM invasivo aumentou em 40% (RT = 1,40; IC95% 1,33–1,47). A taxa de mortalidade do CCU caiu em 58% (RT = 0,42; IC95% 0,32–0,56), e a do CM em 15% (RT = 0,85; IC95% 0,82–0,89). CONCLUSÃO A incidência de carcinomas in situ de CCU e CM aumentou nessas quase duas décadas. A taxa de carcinoma invasivo do CCU diminuiu, e a do CM aumentou. A mortalidade pelos dois cânceres foi reduzida. Observar essas alterações é útil para avaliar o impacto das ações realizadas no período e planejar ações futuras.

    Abstract in English:

    ABSTRACT OBJECTIVES To analyze the magnitude of changes in the incidence and mortality from cervical cancer (CC) and breast cancer (BC) in Campinas, São Paulo State, between the five-year periods of 1991–1995 and 2010–2014. METHODS data on cancer were obtained from the Campinas Population-Based Cancer Registry and data on deaths from the Mortality Information System of the Computing Department of the Unified Health System. Age-standardized incidence and mortality rates were calculated by the direct method, with the respective 95% confidence intervals. The magnitude of the changes was measured by the rate ratio (rate ratio; 95%CI). RESULTS among the periods studied, there was a threefold increase in the detection rate of in situ CC (3.03; 95%CI: 2.64–3.47) and fivefold increase for in situ BC (5.23; 95%CI: 4.98–5.50). The proportion of cases of in situ BC in relation to the total number of cases of BC increased from 3.31% to 11.05%. The incidence rate of invasive CC decreased by 57% (0.43; 95%CI: 0.40–0.47), and the incidence rate of invasive BC increased by 40% (1.40; 95%CI: 1.33–1.47). The mortality rate of the CC decreased by 58% (0.42; 95%CI: 0.32–0.56), and that of BC by 15% (0.85; 95%CI: 0.82–0.89). CONCLUSION the incidence of in situ carcinomas of CC and BC increased in almost two decades. The rate of invasive carcinoma of CC decreased, and that of BC increased. Mortality from both cancers decreased. Observing these changes is useful for assessing the impact of the actions carried out in the period and for planning future actions.
  • Diagnosis, treatment, and notification of syphilis during pregnancy in the state of Goiás, Brazil, between 2007 and 2017 Original Article

    Oliveira, Iana Mundim de; Oliveira, Rívert Paulo Braga; Alves, Rosane Ribeiro Figueiredo

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar a evolução das notificações da sífilis durante a gestação em relação à classificação clínica, ao diagnóstico e ao tratamento no estado de Goiás, entre 2007 e 2017. MÉTODOS Estudo de série temporal com análise de dados fornecidos pela Secretaria Estadual de Saúde de Goiás. Foram analisadas as variáveis relacionadas ao diagnóstico e tratamento das gestantes e seus parceiros, e sua tendência evolutiva ao longo dos anos. Utilizou-se estatística descritiva, cálculo de porcentagens e verificação das tendências de aumento e diminuição por meio do teste de Cochran-Armitage com nível de significância α = 0,05. RESULTADOS Ao todo, 7.774 casos foram notificados no período. A maior porcentagem das notificações ocorreu no segundo trimestre de gestação (39,8%) e correspondeu à sífilis primária (34,1%). O tratamento prescrito com maior frequência foi a penicilina benzatina em dose de 7,2 milhões (43,8%). Entre 2007 e 2017, observou-se tendência crescente nas porcentagens de notificações de sífilis latente (14,1% para 30,7%), secundária (5,2% para 19%) e terciária (4,4% para 11,4%), assim como no tratamento com penicilina benzatina em dose de 7,2 milhões (19,3% para 59,6%). Tendência decrescente foi observada nas porcentagens de notificação de sífilis primária (43,4% para 22,1%) e nos demais esquemas de tratamento. CONCLUSÕES Houve aumento no número de notificações de sífilis latente em gestantes e no tratamento com penicilina na dose de 7.200.000 UI. Também foi observado aumento na completitude dos dados da ficha de notificação nas variáveis de classificação clínica e tratamento, sugerindo melhora no processo de notificação.

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze the evolution of syphilis during pregnancy notification regarding clinical classification, diagnosis and treatment in the state of Goiás, Brazil, between 2007 and 2017. METHODS This is a time-series study, analyzing data provided by the Health Secretariat of the state of Goiás. The variables related to the diagnosis and treatment of pregnant women and their partners were analyzed, and their evolution trend during the years. Descriptive statistics and percentage calculation were used. Cochran-Armitage test with a significance level α = 0.05 was used to determine increase and decrease trends. RESULTS During the period, 7,774 cases were notified. The highest percentage of notifications occurred in the second trimester of pregnancy (39.8%) and corresponded to primary syphilis (34.1%). The most frequent treatment prescribed was benzathine benzylpenicillin with a dosage of 7.2 million (43.8%). Between 2007 and 2017, there was an increasing trend in the notification percentage of latent (14.1% to 30.7%), secondary (5.2% to 19%), and tertiary syphilis (4.4% to 11.4%). The treatment with benzathine benzylpenicillin with a dosage of 7.2 million also increased (19.3% to 59.6%). The percentages of primary syphilis decreased (43.4% to 22.1%), as well as other treatments’ percentages. CONCLUSIONS Latent syphilis notification of pregnant women and treatment with penicillin at the dosage of 7,200,000 IU increased. Notification forms’ data completeness also increased for the variables clinical classification and treatment, suggesting improvements in the notification process.
  • Excess deaths from all causes and by COVID-19 in Brazil in 2020 Original Article

    Santos, Alcione Miranda dos; Souza, Bruno Feres de; Carvalho, Carolina Abreu de; Campos, Marcos Adriano Garcia; Oliveira, Bruno Luciano Carneiro Alves de; Diniz, Eduardo Moraes; Branco, Maria dos Remédios Freitas Carvalho; Queiroz, Rejane Christine de Sousa; Carvalho, Vitória Abreu de; Araújo, Waleska Regina Machado; Silva, Antônio Augusto Moura da

    Abstract in English:

    ABSTRACT OBJECTIVE To estimate the 2020 all-cause and COVID-19 excess mortality according to sex, age, race/color, and state, and to compare mortality rates by selected causes with that of the five previous years in Brazil. METHODS Data from the Mortality Information System were used. Expected deaths for 2020 were estimated from 2015 to 2019 data using a negative binomial log-linear model. RESULTS Excess deaths in Brazil in 2020 amounted to 13.7%, and the ratio of excess deaths to COVID-19 deaths was 0.90. Reductions in deaths from cardiovascular diseases (CVD), respiratory diseases, and external causes, and an increase in ill-defined causes were all noted. Excess deaths were also found to be heterogeneous, being higher in the Northern, Center-Western, and Northeastern states. In some states, the number of COVID-19 deaths was lower than that of excess deaths, whereas the opposite occurred in others. Moreover, excess deaths were higher in men aged 20 to 59, and in black, yellow, or indigenous individuals. Meanwhile, excess mortality was lower in women, in individuals aged 80 years or older, and in whites. Additionally, deaths among those aged 0 to 19 were 7.2% lower than expected, with reduction in mortality from respiratory diseases and external causes. There was also a drop in mortality due to external causes in men and in those aged 20 to 39 years. Moreover, reductions in deaths from CVD and neoplasms were noted in some states and groups. CONCLUSION There is evidence of underreporting of COVID-19 deaths and of the possible impact of restrictive measures in the reduction of deaths from external causes and respiratory diseases. The impacts of COVID-19 on mortality were heterogeneous among the states and groups, revealing that regional, demographic, socioeconomic, and racial differences expose individuals in distinct ways to the risk of death from both COVID-19 and other causes.
  • The socio-environmental production of malaria in three municipalities in the Carajás region, Pará, Brazil Original Article

    Pereira, Alba Lucia Ribeiro Raithy; Miranda, Claudia do Socorro Carvalho; Guedes, Juan Andrade; Oliveira, Rafael Aleixo Coelho de; Campos, Pedro Silvestre da Silva; Palácios, Vera Regina Da Cunha Menezes; Faria, Camylle Maia Costa; Filgueiras, Tainara Carvalho G. M.; Figueiredo, Roberto Carlos; Gonçalves, Nelson Veiga

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar a produção ambiental da malária nos municípios de Marabá, Parauapebas e Canaã dos Carajás, no Pará, entre 2014 e 2018. MÉTODOS Estudo ecológico e transversal a partir de dados epidemiológicos do Sistema de Informações de Vigilância Epidemiológica da Malária, da Secretaria de Saúde do Estado do Pará. Foram utilizados também dados cartográficos do Instituto Brasileiro de Geografia e Estatística (IBGE) e ambientais do projeto TerraClass, do Instituto Nacional de Pesquisas Espaciais (INPE). As análises estatísticas utilizaram o cálculo de percentuais e o teste qui-quadrado e as espaciais as técnicas de Kernel e de Moran global bivariado (I). RESULTADOS Foram analisados 437 casos confirmados de malária, na área e periodo de estudo. O maior percentual de casos ocorreu em indivíduos do sexo masculino, adultos, morador da zona rural, com atividades de garimpagem e agropecuária, sendo o Plasmodium vivax a espécie de maior frequência e o diagnóstico mais utilizado a gota espessa/esfregaço. A distribuição da malária não ocorreu de forma homogênea, com evidências de dependência espacial entre áreas com ocorrência de casos e diferentes tipos de uso da terra. Foram observadas também autocorrelações espaciais relacionadas à alta variabilidade dos tipos antropismos, ocorrida nos municípios. CONCLUSÃO A produção ambiental da malária está associada principalmente à pastagem e à mineração, antropismos relacionados às formas de uso e ocupação da terra nos municípios estudados. As tecnologias de análises de dados espaciais em saúde foram satisfatórias para a construção do cenário epidemiológico da doença.

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze the environmental production of malaria in the municipalities of Marabá, Parauapebas, and Canaã dos Carajás, in Pará, from 2014 to 2018. METHODS This ecological, cross-sectional study used epidemiological data in the Sistema de Informações de Vigilância Epidemiológica da Malária (Malaria Epidemiological Surveillance Information System) from the Secretaria de Saúde do Estado do Pará (State of Pará Health Department), cartographic data from the Brazilian Institute of Geography and Statistics (IBGE), and environmental data in the Projeto TerraClass (TerraClass Project) from the National Institute of Space Research (INPE). Statistical analyses used the chi-square test, while the spatial ones, the kernel and Moran’s (I) global bivariate techniques. RESULTS We analyzed a total of 437 confirmed cases of malaria in the selected area and period. The highest percentage of cases occurred among male miners and farmers, living in rural areas; Plasmodium vivax was the most frequent species; and the most used diagnosis, the thick drop/smear. We also observed a heterogeneous distribution of the disease — with evidence of spatial dependence between incidence areas and different forms of land use, and spatial autocorrelations related to the high variability of anthropic activities in the municipalities. CONCLUSION The environmental production of malaria relates mainly to cattle production and mining — anthropisms related to land use and occupation in the observed municipalities. Spatial data analysis technologies sufficed for the construction of the epidemiological scenario of the disease.
  • Mortality from oral and oropharyngeal cancer: age-period-cohort effect, Brazil, 1983–2017 Original Article

    Perea, Lillia Magali Estrada; Antunes, José Leopoldo Ferreira; Peres, Marco Aurelio

    Abstract in Portuguese:

    RESUMO OBJETIVO Estimar o efeito da idade, período e coorte de nascimento na mortalidade por câncer de boca e orofaringe no Brasil e suas macrorregiões. MÉTODO Foram analisados os óbitos por câncer de boca e orofaringe de 1983 a 2017. Aplicou-se o modelo de regressão de Poisson, utilizando funções estimáveis propostas por Holford. RESULTADOS No período de 1983 a 2017, foram registrados no Brasil 142.634 óbitos por câncer de boca e orofaringe, 81% entre o sexo masculino, e as regiões Sul e Sudeste apresentaram as taxas mais altas. Os maiores efeitos de período foram observados na mortalidade masculina das regiões Sudeste e Centro-Oeste para o período de referência 2003–2007. Nas regiões Norte, Nordeste e Centro-Oeste foi observado aumento do risco de mortalidade nas coortes masculinas mais recentes. Na região Norte o maior risco identificado foi para homens nascidos entre 1973 e 1977 (RR = 1,47; IC95% 1,05–2,08); no Nordeste, para homens nascidos entre 1988 e 1992 (RR = 2,77; IC95% 1,66–4,63); e no Centro-Oeste, para mulheres nascidas entre 1973 e 1977 (RR = 2,01; IC95% 1,19–3,39). Nas regiões Sudeste e Sul, as coortes mais recentes apresentaram taxas de mortalidade mais baixas. O menor risco na região Sudeste foi observado na coorte masculina nascida entre 1978 e 1982 (RR = 0,53; IC95% = 0,45–0,62), e entre 1983 e 1987 na região Sul (RR = 0,25; IC95% 0,12–0,54). CONCLUSÕES A idade teve efeito significativo na mortalidade por câncer de boca e orofaringe em todas as regiões. Nas regiões Norte, Nordeste e Centro-Oeste, foi observado aumento do risco nas coortes mais recentes, enquanto nas regiões Sul e Sudeste essas coortes apresentaram risco menor quando comparadas às coortes mais antigas.

    Abstract in English:

    ABSTRACT OBJECTIVE Estimate the effect of age, period, and birth cohort on mortality from oral and oropharyngeal cancer in Brazil and its macro-regions. METHODS Deaths from oral and oropharyngeal cancer from 1983 to 2017 were analyzed. The Poisson regression model was applied, using estimable functions proposed by Holford. RESULTS From 1983 to 2017, 142,634 deaths from oral and oropharyngeal cancer were registered in Brazil, 81% among men, and the South and Southeast regions had the highest rates. The most significant period effects were observed in male mortality in the Southeast and Central-West regions for the 2003–2007 reference period. In the North, Northeast, and Central-West regions, an increased risk of mortality was observed in the most recent male cohorts. In the North region, the most significant risk identified was for men born during 1973–1977 (RR = 1.47; 95%CI 1.05–2.08); in the Northeast, for men born during 1988–1992 (RR = 2.77; 95%CI 1.66–4.63); and in the Central-West, for women born during 1973–1977 (RR = 2.01; 95%CI 1.19–3.39). In the Southeast and South regions, the most recent cohorts had lower mortality rates. The lowest risk in the Southeast region was observed in the male cohort born during 1978–1982 (RR = 0.53; 95%CI 0.45–0.62) and 1983–1987 in the South region (RR = 0.25; 95%CI 0.12–0.54). CONCLUSIONS Age had a significant effect on mortality from oral and oropharyngeal cancer in all regions. In the North, Northeast, and Central-West regions, an increase in risk was observed in the most recent cohorts, while in the South and Southeast regions, these cohorts presented a lower risk when compared to the older cohorts.
  • Pool of items to measure Primary Health Care workers’ knowledge on healthy eating Original Article

    Reis, Lígia Cardoso dos; Jaime, Patricia Constante

    Abstract in English:

    ABSTRACT OBJECTIVE To develop and validate a self-applicable instrument for measuring primary health care (PHC) workers’ knowledge on healthy eating. METHODS A six-step methodological study to develop and validate a measurement instrument: item development based on the Brazilian Dietary Guidelines’ chapters; content validation with a panel of experts; face validation with potential instrument users; online instrument reevaluation by participants of the content and face validation panels; online application of the instrument with PHC workers; confirmatory factor analysis for construct validation. RESULTS A first version with 25 items underwent content and semantic changes in the content and face validation panels, being reorganized into a second version with 22 items. In the reevaluation, participants considered 21 questions to be clear and representative of the Brazilian Dietary Guidelines, with one being excluded. This third version of the instrument underwent confirmatory factor analysis after being applied online with 209 PHC workers from all Brazilian macroregions. We excluded five items in this analysis: four due to bivariate empty cells and one due to low discrimination capacity. The final model, with 16 items loaded onto one dimension, returned good fit indices [χ2(104) = 119.047, p = 0.1486; RMSEA = 0.026 (90% CI = 0.000 to 0.046), Cfit = 0.979; CFI = 0.924; TLI = 0.913]; its information peak was below average. CONCLUSIONS The instrument proved to be valid and accurate for assessing PHC workers with below average knowledge of the Brazilian Dietary Guidelines. It might contribute to improving actions to promote healthy eating in Brazilian PHC settings by identifying the need for training health professionals.
  • Emergency contraception in university students: prevalence of use and knowledge gaps Original Article

    Barbian, Julia; Kubo, Carolina Yumi; Balaguer, Caroline Soares; Klockner, Julia; Costa, Luiza Maria Venturini da; Ries, Edi Franciele; Bayer, Valéria Maria Limberger

    Abstract in Portuguese:

    RESUMO OBJETIVO Investigar a prevalência de uso e o conhecimento sobre anticoncepção de emergência (AE) de mulheres universitárias de duas instituições de ensino superior. MÉTODOS Estudo transversal com 1.740 graduandas na cidade de Santa Maria (RS), no período de maio a outubro de 2017. As informações foram coletadas por meio de questionário semiestruturado e autoaplicável de 24 questões. As variáveis investigadas foram agrupadas em características sociodemográficas, comportamento sexual e conhecimento da AE. Utilizou-se regressão logística para a análise univariada e multivariada, considerando variáveis que apresentaram p < 0,05. O modelo foi ajustado pelo teste de Hosmer-Lemeshow. RESULTADOS A prevalência de uso da AE entre as graduandas foi de 52,9%. Contudo, apenas 11,9% das entrevistadas receberam orientação sobre a AE, principalmente no que se refere ao modo de uso. Apenas 0,2% das participantes marcou 120 horas como tempo máximo de uso, e 25,7% consideraram a AE abortiva. Houve associação entre uso da AE e idade da primeira relação sexual. CONCLUSÃO Constatou-se alta prevalência de uso da AE entre mulheres universitárias, no entanto, ainda existem diversas lacunas no conhecimento sobre o método, o que demonstra a importância de se discutir esse assunto mais precocemente e planejar ações de caráter informativo.

    Abstract in English:

    ABSTRACT OBJECTIVE Investigate prevalence of use and knowledge about emergency contraception (EC) among female university students from two higher education institutions. METHODS Cross-sectional study with 1,740 undergraduates in the city of Santa Maria (RS), from May to October 2017. Information was collected in a semi-structured and self-administered 24-question questionnaire. The investigated variables were grouped into sociodemographic characteristics, sexual behavior, and knowledge of EC. Logistic regression was used for univariate and multivariate analysis, considering variables that presented p < 0.05. The model was adjusted using the Hosmer-Lemeshow test. RESULTS The prevalence of EC use among undergraduates was 52.9%. However, only 11.9% of respondents received guidance on EC, especially on how to use it. Only 0.2% of the participants marked 120 hours as the maximum time of use, and 25.7% considered the EC to be abortive. EC use was associated with the age of first sexual intercourse. CONCLUSION EC use had a high prevalence among female university students, however, several gaps in method knowledge still exists and it demonstrates the importance of discussing this issue earlier and planning actions of an informative nature.
  • Mortality, sarcopenic obesity, and sarcopenia: Frailty in Brazilian Older People Study – FIBRA – RJ Original Article

    Campos, Glaucia Cristina de; Lourenço, Roberto Alves; Molina, Maria del Carmen Bisi

    Abstract in English:

    ABSTRACT OBJECTIVE To investigate the risk of mortality associated with sarcopenic obesity (SO), obesity (OB), and sarcopenia in elderlies. METHODS We analyzed longitudinal data from 270 participants > 65 years of age of Phase III of the Study on Frailty in Brazilian Older People (FIBRA–RJ–2012). Socioeconomic, demographic, lifestyle, morbidity, and functional data were collected by home based interviews. DXA and body composition assessment was conducted in a laboratory. In women, OB was diagnosed when body fat percentage ≥ 38% and sarcopenia by an Appendicular Lean Mass Index (ALMI) < 6.00 kg/m2 and muscle strength < 16 Kgf. In men, OB was diagnosed when body fat percentage ≥ 27%, and sarcopenia was diagnosed with ALMI < 7.00 kg/m2 and muscle strength < 27 Kgf. SO was assessed by combining variables used to diagnose obesity and sarcopenia. The probabilistic linkage method was used to obtain deaths in the 2012-January 2017 period from the Brazilian Mortality Registry. Cox regression models were tested, and crude and adjusted hazard ratio calculations were conducted. RESULTS After adjusting for sex, age, race/skin color, walking as an exercise, and hypertension, individuals with sarcopenia were 5.7 times more likely to die (95%CI: 1.17–27.99) than others without sarcopenia and obesity. CONCLUSION A high risk of death was observed in individuals with sarcopenia. These results show the need for preventive strategies of early detection and treatment in order to increase survival employing multimodal interventions.
  • Factors associated with common mental disorders: a study based on clusters of women Original Article

    Grapiglia, Cássio Zottis; Costa, Juvenal Soares Dias da; Pattussi, Marcos Pascoal; Paniz, Vera Maria Vieira; Olinto, Maria Teresa Anselmo

    Abstract in Portuguese:

    RESUMO OBJETIVO Identificar fatores associados aos transtornos mentais comuns (TMC) em uma amostra de mulheres adultas no Sul do Brasil. MÉTODOS Em estudo de base populacional composto por 1.128 mulheres, foram investigadas variáveis explicativas demográficas, socioeconômicas, comportamentais e de saúde/doença. Cinco grupos-resposta foram explorados: um grupo com transtornos mentais comuns – ponto de corte 6/7 no Self-Reporting Questionnaire 20 (SRQ-20) – e outros quatro correspondentes aos diferentes clusters encontrados através da técnica de clusterização por classe latente, também a partir do SRQ-20. Esses quatro clusters (baixo, médio-depressivo, médio-digestivo e alto) foram denominados com base nas pontuações médias do SRQ-20 em cada grupo e nos padrões de resposta das variáveis e características fatoriais. O cluster “baixo” compreendeu mulheres com menores escores no SRQ-20 e, portanto, com menor probabilidade de apresentarem TMC. Já o cluster “alto”, com valores médios elevados no SRQ-20, esteve relacionado a maior morbidade psiquiátrica. Utilizou-se a técnica de regressão de Poisson, com comparação entre os achados dos diferentes grupos. RESULTADOS Foram identificadas 10 variáveis como fatores associados aos TMC. Idade, escolaridade, tabagismo, atividade física, percepção de saúde e número de consultas foram as variáveis comuns para as análises com ponto de corte assim como nas baseadas em clusters. Etilismo pesado esteve associado somente quando avaliada a amostra como ponto de corte. Já classe econômica, situação laboral e presença de doenças crônicas estiveram associadas somente quando analisada a amostra por clusters. No cluster “alto”, houve associação significativa com classes econômicas mais baixas (D ou E), tabagismo, inatividade física, presença de doenças crônicas e percepção de saúde negativa. CONCLUSÕES Diferentes fatores associados foram identificados segundo os grupos-resposta considerados. Novos enfoques que possibilitem identificar subgrupos de indivíduos com características e fatores associados específicos poderiam contribuir para um entendimento mais apurado dos TMC, servindo de base para intervenções em saúde.

    Abstract in English:

    ABSTRACT OBJECTIVE to identify factors associated with common mental disorders (CMD) in a sample of adult women in Southern Brazil. METHODS This population-based study, composed of 1,128 women, investigated socioeconomic, behavioral and health/disease explanatory demographic variables. Five response groups were explored: one group with common mental disorders – cut-off point 6/7 in the Self-Reporting Questionnaire 20 (SRQ-20) – and four others corresponding to the different clusters found using the latent class clustering technique, also from the SRQ-20. These four clusters (low, medium-depressive, medium-digestive and high) were named (denominated) based on the mean scores in the SRQ-20 in each group and on the response patterns of the variables and factorial characteristics. The “low” cluster comprised women with lower SRQ-20 scores and, therefore less likely to present CMD. The “high” cluster, with high mean values in the SRQ-20, was related to higher psychiatric morbidity. We used the Poisson regression technique to compare the findings of the different groups. RESULTS We identified ten variables as factors associated with CMD. Age, education, smoking, physical activity, perception of health and number of medical appointments were the common variables for the cut-off point and cluster-based analyses. Heavy alcohol use was associated only when the sample was evaluated as a cut-off point. Social class, work situation and existence of chronic diseases were associated only when the sample was analyzed by clusters. There was a significant association in the “high” cluster with lower classes (D or E), smoking, physical inactivity, existence of chronic diseases and negative perception of health. CONCLUSION We identified different associated factors according to the response groups considered. New approaches allowing identification of subgroups of individuals with specific characteristics and associated factors may contribute for a more accurate understanding of CMD and provide the basis for health interventions.
  • Population-level seropositivity trend for SARS-Cov-2 in Rio Grande do Sul, Brazil Original Article

    Barros, Aluísio J D; Victora, Cesar G; Menezes, Ana M B; Horta, Bernardo L; Barros, Fernando C; Hartwig, Fernando P; Victora, Gabriel D; Vidaletti, Luis Paulo; Silveira, Mariângela F; Mesenburg, Marilia A; Jacques, Nadège; Struchiner, Cláudio J; Brust, Flávia Roberta; Dall’Agnol, Marinel M; Delamare, Ana Paula Longaray; François, Carlos Henrique R; Ikeda, Maria Letícia R; Pellegrini, Débora C P; Reuter, Cézane Priscila; Silva, Shana G da; Dellagostin, Odir A; Hallal, Pedro C

    Abstract in English:

    ABSTRACT OBJECTIVE To describe the evolution of seropositivity in the State of Rio Grande do Sul, Brazil, through 10 consecutive surveys conducted between April 2020 and April 2021. METHODS Nine cities covering all regions of the State were studied, 500 households in each city. One resident in each household was randomly selected for testing. In survey rounds 1–8 we used the rapid WONDFO SARS-CoV-2 Antibody Test (Wondfo Biotech Co., Guangzhou, China). In rounds 9–10, we used a direct ELISA test that identifies IgG to the viral S protein (S-UFRJ). In terms of social distancing, individuals were asked three questions, from which we generated an exposure score using principal components analysis. RESULTS Antibody prevalence in early April 2020 was 0.07%, increasing to 10.0% in February 2021, and to 18.2% in April 2021. In round 10, self-reported whites showed the lowest seroprevalence (17.3%), while indigenous individuals presented the highest (44.4%). Seropositivity increased by 40% when comparing the most with the least exposed. CONCLUSIONS The proportion of the population already infected by SARS-Cov-2 in the state is still far from any perspective of herd immunity and the infection affects population groups in very different levels.
  • Potentially inappropriate prescribing in older adults in Mexico Original Article

    Saturno-Hernández, Pedro Jesús; Poblano-Verástegui, Ofelia; Acosta-Ruiz, Omar; Bautista-Morales, Arturo Cuauhtémoc; Gómez-Cortez, Patricia María; Alcántara-Zamora, José Luis; Gutiérrez-Robledo, Luis Miguel

    Abstract in Spanish:

    RESUMEN OBJETIVO Identificar y cuantificar la prescripción potencialmente inapropiada (PPI) y otros problemas en la prescripción de medicamentos en los servicios públicos de atención médica en un estudio poblacional en los tres niveles de complejidad existentes en México. MÉTODOS Análisis descriptivo del Estudio de Satisfacción de Usuarios del Sistema de Protección Social en Salud 2014–2016, sección de prescripción y surtimiento de medicamentos, para obtener la prevalencia de PPI en adultos mayores (≥ 65 años) con base en listados Beers, STOPP, Prescrire y BSP mediante indicadores de prescripción en AM, uno por cada listado. RESULTADOS Al 67% de los AM se les prescribió al menos un medicamento, con una media de 2.7 medicamentos por receta. La prevalencia de PPI fue del 74% según los criterios BSP, del 67% según el listado STOPP, del 59% con los criterios Beer y del 20% con Prescrire. Las prescripciones PPI más frecuentes fueron los AINES, vasodilatadores y las sulfonilureas. CONCLUSIONES El uso de PPI en AM es alto en México. La mayor prevalencia encontrada en este estudio puede ser reflejo de la utilización de una fuente con representatividad poblacional. La utilización parcial y adaptaciones de los criterios dificultan la comparabilidad entre estudios, sin embargo, los criterios STOPP son los que más altas prevalencias han presentado debido a que abarca un mayor número de medicamentos y su uso más habitual en el primer nivel de atención.

    Abstract in English:

    ABSTRACT OBJECTIVE To identify and quantify potentially inappropriate prescribing (prescripción potencialmente inapropiada, PPI) and other drug prescribing problems in public health care services in a population-based study at the three existing levels of complexity in Mexico. METHODS Descriptive analysis of the Study on Satisfaction of Users of the Social Protection System in Health 2014–2016, prescription and drug supply section, to obtain the prevalence of PPI in older adults (≥ 65 years), based on Beers, STOPP, Prescrire and BSP listings using AM (older adults) prescription indicators, one for each listing. RESULTS Most older adults (67%) were prescribed at least one medication, with a mean of 2.7 medications per prescription. The PPI prevalence was 74% according to the BSP criteria, 67% according to the STOPP listing, 59% with the Beer criteria, and 20% with Prescrire. The most frequent PPI prescriptions were NSAIDs, vasodilators and sulfonylureas. CONCLUSIONS The use of PPIs in AM is high in Mexico. The higher prevalence found in this study may reflect the use of a source with population representativeness. The partial use and adaptations of the criteria make difficult comparing the studies; however, the STOPP criteria are the ones with the highest prevalence, as they cover a greater number of drugs and their use is more common in the first level of care.
  • Prevalence of symptoms of COVID-19 in the state of Rio Grande do Sul: results of a population-based study with 18,000 participants Original Article

    Mesenburg, Marilia Arndt; Hallal, Pedro Curi; Menezes, Ana Maria Baptista; Barros, Aluísio J D; Horta, Bernardo Lessa; Hartwig, Fernando Pires; Jacques, Nadege; Pellanda, Lucia Campos; Zelmanowicz, Alice de Medeiros; Vergani, Daiane Oliveira Pereira; Ries, Edi Franciele; Harter, Jenifer; Martínez-Mesa, Jeovany; Carneiro, Marcelo; Estima, Sonara Lucia; Heck, Thiago Gomes; Silveira, Mariangela Freitas da

    Abstract in Portuguese:

    RESUMO OBJETIVO Avaliar prevalência de relato de sintomas característicos de covid-19 entre indivíduos com e sem anticorpos e identificar aqueles com maior capacidade de predição da presença de anticorpos contra o SARS-CoV-2. MÉTODOS O presente estudo usa dados coletados nas fases de 5 a 8 do Epicovid-19-RS. A presença de anticorpos contra o SARS-CoV-2 foi avaliada por um teste rápido. Avaliou-se também a ocorrência dos sintomas tosse, febre, palpitações, dor de garganta, dificuldade para respirar, alterações no paladar e olfato, vômito, diarreia, dor no corpo, tremedeira e dor de cabeça, desde março de 2020. Então, calculou-se a capacidade de predição dos sintomas avaliados em relação a presença de anticorpos. RESULTADOS Nas fases de 5 a 8, 18 mil indivíduos foram entrevistados e 181 apresentaram anticorpos contra covid-19. A proporção de indivíduos assintomáticos foi de 19,9% entre participantes com anticorpos e 49,7% entre aqueles sem anticorpos. Todos os sintomas foram relatados com maior frequência por indivíduos com presença de anticorpos. A divisão da prevalência de sintomas entre indivíduos com anticorpos pela prevalência entre indivíduos sem anticorpos evidenciou as seguintes razões de prevalência: para alterações de olfato ou paladar (9,1), febre (4,2), tremedeira (3,9), dificuldade respiratória (3,2) e tosse (2,8 vezes). Anosmia e febre foram os sintomas com maior capacidade de predizer a presença de anticorpos. CONCLUSÃO A prevalência de sintomas foi maior entre indivíduos com anticorpos contra SARS-CoV-2. A proporção de indivíduos assintomáticos foi baixa. Alteração de olfato ou paladar e febre foram os sintomas que mais predizem a presença de anticorpos. Esses resultados podem auxiliar a identificação de casos prováveis, contribuindo para o diagnóstico clínico e triagem de pacientes para testagem e orientação de isolamento em casos positivos, especialmente em cenários de escassez de testes diagnósticos de covid-19.

    Abstract in English:

    ABSTRACT OBJECTIVE To evaluate the prevalence of reports of symptoms of COVID-19 among individuals with and without antibodies and identify those with greater capability to predict the presence of antibodies against SARS-CoV-2. METHODS The study uses data collected in phases 5 to 8 of Epicovid-19-RS. The presence of antibodies against SARS-CoV-2 was evaluated by a rapid test. The occurrence of cough, fever, palpitations, sore throat, difficulty breathing, changes in taste and smell, vomiting, diarrhea, body pain, shaking, and headache since March 2020 was also evaluated. Then, the capability to predict the evaluated symptoms concerning the presence of antibodies was calculated. RESULTS A total of 18,000 individuals were interviewed and 181 had antibodies against COVID-19 in phases 5 to 8. The proportion of asymptomatic individuals was 19.9% among participants with antibodies and 49.7% among those without antibodies. All symptoms were reported more frequently by individuals with antibodies. The division of the prevalence of symptoms among individuals with antibodies by the prevalence among individuals without antibodies showed the following prevalence ratios: for changes in smell or taste (9.1), fever (4.2), tremors (3.9), breathing difficulty (3.2) and cough (2.8 times). Anosmia and fever were the symptoms with a greater capability to predict the presence of antibodies. CONCLUSION The prevalence of symptoms was higher among individuals with antibodies against SARS-CoV-2. The proportion of asymptomatic individuals was low. Altered smell or taste and fever were the symptoms that most predict the presence of antibodies. These results can help to identify probable cases, contributing to the clinical diagnosis and screening of patients for testing and isolation guidance in positive cases, especially in scenarios of the scarcity of diagnostic COVID-19 tests.
  • Profile of hospitalizations for neoplasms in the Brazilian Unified Health System: a time-series study Original Article

    Machado, Analy da Silva; Machado, Anaely da Silva; Guilhem, Dirce Bellezi

    Abstract in Portuguese:

    RESUMO OBJETIVO Descrever o perfil das internações pelo Sistema Único de Saúde (SUS) por diagnóstico de câncer no Brasil no período de 2008 a 2018. MÉTODOS Estudo de séries temporais da taxa de internação por neoplasias malignas no SUS. Os dados foram extraídos do Sistema de Informações Hospitalares do DataSUS. A tendência foi estimada por regressão linear generalizada, aplicando o procedimento de Prais-Winsten. RESULTADOS No período de 2008 a 2018, a taxa de internação por neoplasias malignas apresentou tendência crescente no SUS, com variação anual de 10,7% (p < 0,001; IC = 9,4–11,7). Observou-se tendência crescente de internações em todas as regiões do Brasil, com exceção da região Norte, que apresentou comportamento estacionário. A região Nordeste foi a que apresentou maior variação anual (13,5%; p < 0,001), enquanto as regiões Sul e Sudeste apresentaram as maiores taxas de internação por 100 mil habitantes, 506 e 325 respectivamente. Observou-se tendência crescente significativa nas internações de crianças de 0 a 9 anos de idade (variação anual = 10,9%; p < 0,001), de jovens entre 10 e 19 anos (variação anual = 6,9%; p < 0,001) e de idosos acima de 60 anos (variação anual = 7,9%; p < 0,001). Entre as mulheres, as internações ocorreram majoritariamente por neoplasia maligna de mama (variação anual = 13,2%; p < 0,001), e entre os homens por neoplasia maligna de próstata (variação anual = 4,7%; p < 0,001). CONCLUSÃO As internações por neoplasias malignas mostraram tendência crescente, em consonância com o aumento da incidência de câncer, em particular das neoplasias mais incidentes entre homens e mulheres. Apesar da região Nordeste ter apresentado maior variação no período, as regiões Sul e Sudeste apresentaram as maiores taxas de internação do país. Observou-se também aumento das internações entre a população jovem (entre 0 e 19 anos) e mais idosa (acima de 60 anos). As internações por neoplasias de colo de útero nas mulheres, embora ainda sejam a terceira causa de internações, apresentaram comportamento decrescente.

    Abstract in English:

    ABSTRACT OBJECTIVE Describe the profile of hospitalizations for cancer diagnosis in Brazil from 2008 to 2018 at Unified Health System (SUS). METHODS Time series study of hospitalization rate for malignant neoplasms at SUS. Data were extracted from the Hospital Information System of DataSUS. The trend was estimated using generalized linear regression, applying the Prais-Winsten estimation procedure. RESULTS From 2008 to 2018, the hospitalization rate for malignant neoplasms showed an increasing trend at SUS, with an annual variation of 10.7% (p < 0.001; CI = 9.4–11.7). An increasing trend of hospitalizations in all regions of Brazil was observed, except in the Northern region, which remained unchanged. The Northeastern region presented the highest annual variation (13.5%; p < 0.001), whereas the Southern and Southeastern regions had the highest hospitalization rates per 100,000 inhabitants, resulting in 506 and 325 hospitalizations, respectively. We observed a significant increasing trend in hospitalizations of children aged 0 to 9 years (annual variation = 10.9%; p < 0.001); young people, 10 and 19 years (annual variation = 6.9%; p < 0.001); and older adults; over 60 years (annual variation = 7.9%; p < 0.001). Among women, hospitalizations occurred mainly due to malignant neoplasm of the breast (annual variation = 13.2%; p < 0.001); and among men, malignant neoplasm of the prostate (annual variation = 4.7%; p < 0.001). CONCLUSION Hospitalizations for malignant neoplasms showed an increasing trend, in line with the increased incidence of cancer, in particular, the most frequent neoplasms between men and women. Although the Northeastern region showed the highest variation in the period, the Southern and Southeastern regions had the highest hospitalization rates in the country. We also observed an increase in hospitalizations among the young (between 0 and 19 years old) and older adults (over 60 years) population. Hospitalizations for neoplasm of the cervix in women, although still the third cause of hospitalizations, showed decreasing behavior.
  • Sexual violence against women in the Western Amazon Original Article

    Cargnin, Júlia Souza Santos; Luna, Juliana Scholtão; Aguiar, Débora Melo de; Rodrigues, Bárbara Teles Cameli; Azevedo Filho, Aldir Alves de; Silveira, Rodrigo Pinheiro

    Abstract in Portuguese:

    RESUMO OBJETIVO: Caracterizar os casos de violência sexual sofridos por mulheres notificadas pelo Sistema de Informação de Agravos de Notificação no município de Rio Branco (AC) no período de 2011 a 2016. MÉTODOS: Estudo descritivo com base nas informações do Sistema de Informação de Agravos de Notificação. A população do estudo foi constituída por mulheres vítimas de violência sexual notificadas no município de Rio Branco (AC), de 2011 a 2016. RESULTADOS: Os resultados da investigação apresentam maior número de notificação durante o ano de 2012, se destacando entre as vítimas aquelas com idade entre 10 e 14 anos, solteiras, pardas e com 5 a 8 anos de formação educacional. O local de ocorrência mais notificado foi a residência, predominando agressor único, do sexo masculino e não alcoolizado. DISCUSSÃO: O grande número de notificações de gestantes na faixa etária de 10 a 14 anos corresponde à notificação compulsória do estupro de vulnerável, identificado no momento de realização do pré-natal ou parto. CONCLUSÃO: Confirmou-se a suscetibilidade à violência sexual de mulheres jovens de Rio Branco, levantando a problemática do casamento infantil e da gravidez na adolescência.

    Abstract in English:

    ABSTRACT OBJECTIVE: To characterize sexual violence cases suffered by women notified by the Sistema de Informação de Agravos de Notificação (Information System for Notifiable Diseases) in the city of Rio Branco (AC - Brazil) from 2011 to 2016. METHODS: Descriptive study based on information from the Notifiable Diseases Information System. The study population consisted on women victims of sexual violence reported in the city of Rio Branco (AC), from 2011 to 2016. RESULTS: The results show a higher number of notifications during 2012, especially among single, brown, and aged between 10 and 14 years victims; usually they have 5 to 8 years of schooling. Normally violence occurred in residences and by a single aggressor, male and non-alcoholic. DISCUSSION: The large number of notifications of pregnant women aged 10 to 14 years corresponds to the compulsory notification of rape of a vulnerable person, identified at the time of prenatal care or childbirth. CONCLUSION: We confirm the susceptibility to sexual violence of young women in Rio Branco, raising the issue of child marriage and teenage pregnancy.
  • Running away from the jab: factors associated with COVID-19 vaccine hesitancy in Brazil Original Article

    Paschoalotto, Marco Antonio Catussi; Costa, Eduardo Polena Pacheco Araújo; Almeida, Sara Valente de; Cima, Joana; Costa, Joana Gomes da; Santos, João Vasco; Barros, Pedro Pita; Passador, Claudia Souza; Passador, João Luiz

    Abstract in English:

    ABSTRACT OBJECTIVE: To investigate how sociodemographic conditions, political factors, organizational confidence, and non-pharmaceutical interventions compliance affect the COVID-19 vaccine hesitancy in Brazil. METHODS: Data collection took place between November 25th, 2020 and January 11th, 2021 using a nationwide online survey. Subsequently, the researches performed a descriptive analysis on the main variables and used logistic regression models to investigate the factors associated with COVID-19 vaccine hesitancy. RESULTS: Less concern over vaccine side effects could improve the willingness to be vaccinated (probability changed by 7.7 pp; p < 0.10). The current vaccine distrust espoused by the Brazilian president is associated with vaccine hesitancy, among his voter base. Lower performance perception (“Very Bad” with 10.7 pp; p < 0.01) or higher political opposition (left-oriented) regarding the current presidency is associated with the willingness to be vaccinated. Higher compliance with non-pharmaceutical interventions (NPIs) is usually positively associated with the willingness to take the COVID-19 vaccine (+1 score to NPI compliance index is associated with higher willingness to be vaccinated by 1.4 pp, p < 0.05). CONCLUSION: Willingness to be vaccinated is strongly associated with political leaning, perceived federal government performance, vaccine side effects, and compliance with non-pharmaceutical interventions (NPIs).
  • Cross-cultural Adaptation of the Adverse Childhood Experiences International Questionnaire Original Article

    Pereira, Flávia Garcia; Viana, Maria Carmen

    Abstract in Portuguese:

    RESUMO OBJETIVO: Traduzir, adaptar e validar o conteúdo do Adverse Childhood Experiences International Questionnaire para uma versão em português, vigente no Brasil, nomeada como Questionário Internacional de Experiências Adversas na Infância. MÉTODOS: Trata-se de um estudo metodológico de adaptação transcultural de instrumentos de avaliação, em que são apresentados os resultados da equivalência semântica entre o instrumento original e a versão adaptada. A equivalência semântica do instrumento envolveu as seguintes etapas: 1) duas traduções e uma síntese das traduções; 2) duas retraduções; 3) validação de conteúdo realizado por oito profissionais da área da saúde; 4) síntese das retraduções; 5) pré-testes para avaliar a aceitabilidade, a compreensão e o impacto emocional das questões; e, por fim, 6) a elaboração da versão final do instrumento. RESULTADOS: A versão adaptada demonstrou ser de fácil aplicação e compreensão e obteve boa equivalência semântica quando comparada à original. As propriedades psicométricas do instrumento devem, ainda, ser avaliadas. Limitações e recomendações para a melhoria do instrumento e para a sua utilização são apresentadas. CONCLUSÃO: O processo de adaptação transcultural do Adverse Childhood Experiences International Questionnaire proporcionou uma versão adaptada para o português vigente no Brasil.

    Abstract in English:

    ABSTRACT OBJECTIVE: To translate, adapt and validate the contents of the Adverse Childhood Experiences International Questionnaire to a Portuguese version, to be used in Brazil, named Questionário Internacional de Experiências Adversas na Infância. METHODS: This is a methodological study of cross-cultural adaptation of evaluation instruments presenting the results of semantic equivalence between the original instrument and the adapted version. The semantic equivalence of the instrument involved the following steps: 1) two translations and a synthesis of the translations; 2) two retranslations; 3) validation of contents by eight health workers; 4) synthesis of the retranslations; 5) pre-tests to assess acceptability, understanding and emotional impact of the questions; and, finally, 6) writing of the final version of the instrument. RESULTS: the adapted version proved to be easy to apply and to understand and achieved good semantic equivalence when compared to the original version. The psychometric properties of the instrument still need to be evaluated. Limitations and recommendations for improving the instrument and its use are presented. CONCLUSION: The process of cross-cultural adaptation of the Adverse Childhood Experiences International Questionnaire resulted in an adapted version to Brazilian Portuguese.
  • PNAB 2017 and the number of community health agents in primary care in Brazil Original Article

    Freire, Deborah Ellen Wanderley Gomes; Freire, Aldelany Ramalho; Lucena, Edson Hilan Gomes de; Cavalcanti, Yuri Wanderley

    Abstract in Portuguese:

    RESUMO OBJETIVO: Analisar o efeito da Política Nacional de Atenção Básica (PNAB) de 2017 no quantitativo de agentes comunitários de saúde, por equipe de atenção primária em saúde. MÉTODOS: Trata-se de um estudo transversal, descritivo e analítico, utilizando dados disponibilizados na plataforma e-Gestor da Atenção Básica, do Ministério da Saúde, sobre os 5.570 municípios brasileiros, entre outubro de 2017 e dezembro de 2019. A sobrevida do número de municípios que não reduziram o quantitativo de agentes comunitários de saúde foi analisada segundo a região do país, índice de desenvolvimento humano (IDH), índice de desigualdade de Gini e porte populacional. A Regressão de Cox foi utilizada para analisar os fatores associados à redução do número de ACS após um mês e, a partir de então, a cada três meses, até completarem os dois anos da publicação da portaria da PNAB 2017, considerando-se p < 0,05. CONCLUSÕES: Após dois anos, a maior redução foi observada em municípios das regiões Centro-Oeste e Sul, que apresentaram IDH alto, menos desiguais e com maior porte populacional. Municípios do Centro-Oeste (HR = 1,256) apresentaram maior chance de redução do número de ACS comparado à região Norte. Municípios com maior IDH (HR = 1,053) e maior porte populacional (HR = 1,186) também apresentaram maior chance de reduzir o número de agentes comunitários de saúde. Portanto, após a PNAB 2017, houve um aumento ao longo dos meses no número de municípios que reduziram a quantidade de agentes comunitários em saúde na atenção primária de saúde.

    Abstract in English:

    ABSTRACT OBJECTIVE: To analyze the effect of the 2017 Basic Primary Care Policy (PNAB) on the number of community health agents per primary health care team. METHODS: This is a cross-sectional, descriptive and analytical study using data available on the Ministry of Health platform called e-Gestor da Atenção Básica, about Brazil's 5,570 towns between October 2017 and December 2019. The survival of the number of towns that did not reduce the number of community health agents was analyzed according to region of the country, the Human Development Index (HDI), the Gini Inequality Index and population size. Cox regression was used to analyze the factors associated with a reduction in the number of CHAs after one month and, from then on, every three months until two years had passed since the publication of the 2017 PNAB Ordinance, considering p < 0.05. CONCLUSIONS: After two years, the greatest reduction was observed in towns in the Midwest and South regions, which presented a high HDI, lower inequality and larger populations. Towns in the Midwest (HR = 1.256) had a higher chance of reducing the number of CHAs compared to the North region. Towns with a higher HDI (HR = 1.053) and larger population size (HR = 1.186) were also more likely to reduc the number of community health agents. Therefore, after the 2017 PNA, the number of towns reducing the amount of community health workers in primary health care increased over the months
  • Changes in blood pressure according to stature in Mexican adults Original Article

    Perez-Sastre, Miguel A.; Ortiz-Hernandez, Luis

    Abstract in Spanish:

    RESUMEN OBJETIVO: Determinar si existen diferencias en el cambio de la presión arterial a lo largo del tiempo de acuerdo con la estatura en adultos mexicanos. MÉTODOS: Se analizaron las bases de datos de la Encuesta Nacional de Niveles de Vida de los Hogares en la que se siguieron a los miembros de los hogares entre el 2005 y 2009. Se seleccionaron a los participantes que tenían entre 20 y 40 años (n = 7,130). Se estimaron modelos multinivel con intercepto aleatorio para analizar diferencias en los cambios de la presión arterial de acuerdo con la estatura. Los modelos fueron ajustados por edad, tamaño de localidad, región geográfica, ingreso familiar per cápita, índice cintura-estatura, actividad física, consumo de alcohol, tabaquismo y uso de antihipertensivos. RESULTADOS: En ambos sexos, la presión arterial inicial tendió a ser menor conforme la estatura fuese menor. Las diferencias se mantuvieron tanto en los modelos crudos como en los modelos ajustados. En los varones los incrementos de la presión sistólica a lo largo del tiempo tendieron a ser mayores conforme la estatura era más alta. CONCLUSIONES: Contrario a lo observado en países de altos ingresos, en México la presión arterial se asoció positivamente con la estatura.

    Abstract in English:

    ABSTRACT OBJECTIVE: To determine the possible existence of differences in blood pressure change over time according to stature in Mexican adults. METHODS: We analyzed the National Household Living Standards Survey databases following household members between 2005 and 2009. We selected participants who were between 20 and 40 years old (n = 7,130). We estimated multilevel models with random intercept to analyze differences in blood pressure changes according to stature. We adjusted the models for age, locality size, geographic region, per capita family income, waist-to-height ratio, physical activity, alcohol consumption, smoking, and use of antihypertensive drugs. RESULTS: In both sexes, baseline blood pressure tended to be lower as stature decreased. The differences were maintained in both the crude and adjusted models. In men, the increases in systolic pressure over time tended to be higher as stature increased. CONCLUSIONS: Contrary to what studies observed in high-income countries, in Mexico blood pressure was positively associated with stature.
  • Integration among national health information systems in Brazil: the case of e-SUS Primary Care Original Article

    Coelho Neto, Giliate Cardoso; Andreazza, Rosemarie; Chioro, Arthur

    Abstract in Portuguese:

    RESUMO OBJETIVO: Medir o grau de integração do Prontuário Eletrônico do Cidadão (PEC) da Estratégia e-SUS Atenção Básica (e-SUS AB) com outros Sistemas Nacionais de Informação em Saúde (SNIS), o relacionando à estrutura político-organizacional interna do Ministério da Saúde (MS). MÉTODOS: Trata-se de um estudo de caso de caráter qualitativo. A coleta de dados foi realizada através de análise documental e entrevistas semiestruturadas. Na primeira etapa buscou-se esclarecer quantos SNIS estiveram em uso na Atenção Básica do Sistema Único de Saúde entre 2013 e 2017. Em seguida, para medir a integração, foi aplicado como critério a manutenção das interfaces de captação de dados pelo Ministério da Saúde, mesmo após a implantação do PEC/e-SUS AB. RESULTADOS: Foram identificados 31 SNIS na Atenção Básica. Observou-se que 12 deles foram completamente integrados e em 15 não houve nenhuma unificação de interfaces com o PEC/e-SUS AB. Outros 4 tiverem integração parcial. Ao correlacionar esses dados com a estrutura político-organizacional do MS, verificou-se uma maior integração com os sistemas geridos pelo Departamento de Atenção Básica e uma persistência da fragmentação com os SNIS, especialmente aqueles sob gestão da Secretaria de Vigilância em Saúde. A disparidade entre a integração do PEC/e-SUS AB com os SNIS da Vigilância em Saúde é um sinal da persistência da divisão e da falsa dicotomia entre práticas e processos de Assistência à Saúde e Vigilância em Saúde no Ministério da Saúde – mesmo após 30 anos da fundação do SUS e unificação das estruturas estatais da assistência hospitalar previdenciária e da saúde pública federal no MS. CONCLUSÃO: Apesar de ainda insuficiente, a integração de sistemas efetivada pela Estratégia e-SUS AB, que tem foco na redução de interfaces de usuário, pode ser considerada um fato novo na agenda da política de informação e informática do SUS.

    Abstract in English:

    ABSTRACT OBJECTIVE: To measure the degree of integration of the Electronic Citizen’s Record (PEC - Prontuário Eletrônico do Cidadão) of the e-SUS Primary Care Strategy (e-SUS AB - Estratégia e-SUS Atenção Básica) in the view of other Brazilian´s National Health Information Systems (SNIS - Sistemas Nacionais de Informação em Saúde), relating to the internal political-organizational structure of the Brazilian Ministry of Health (MH). METHODS: This is a qualitative case study. Data collection was carried out through document analysis and semi-structured interviews. In the first stage, we sought to clarify how many SNIS were in use in the Primary Care (PC) of the Unified Health System between 2013 and 2017. Then, we defined as criterion the maintenance of data collection interfaces by the Ministry of Health even after the implementation of the PEC/e-SUS Primary Care in order to measure the integration. RESULTS: 31 SNIS were identified in Primary Care. We observed that 12 of them were completely integrated and 15 presented no unification of interfaces related to PEC/e-SUS Primary Care. Another 4 have partial integration. By correlating these data with the political-organizational structure of the MS, we observed a greater integration with the systems managed by the Department of Primary Care and a persisted fragmentation in SNIS, especially those under the management of the Health Surveillance Department (Secretaria de Vigilância em Saúde). The disparity between the integration of the PEC/e-SUS Primary Care with the Health Surveillance SNIS is a sign of the persistence of the division and the false dichotomy between Health Care and Health Surveillance practices and processes in the Ministry of Health – even 30 years after the foundation of the SUS and unification of the state structures of social security hospital care and federal public health in MH. CONCLUSION: Although still insufficient, the systems integration carried out by the e-SUS Primary Care Strategy, which focuses on reducing user interfaces, can be considered a new fact on the SUS information and information policy agenda.
  • Temporal trend of tuberculosis incidence and its spatial distribution in Macapá – Amapá Original Article

    Giacomet, Clóvis Luciano; Santos, Marcio Souza; Berra, Thaís Zamboni; Alves, Yan Mathias; Alves, Luana Seles; Costa, Fernanda Bruzadelli Paulino da; Ramos, Antonio Carlos Vieira; Crispim, Juliane de Almeida; Monroe, Aline Aparecida; Pinto, Ione Carvalho; Fiorati, Regina Célia; Arcoverde, Marcos Augusto Moraes; Gomes, Dulce; Freitas, Giselle Lima de; Yamamura, Mellina; Arcêncio, Ricardo Alexandre

    Abstract in Portuguese:

    RESUMO OBJETIVO: Avaliar a tendência temporal da incidência da tuberculose após a implementação do teste rápido molecular, identificar se a tuberculose apresenta variação sazonal e classificar o território de acordo com a densidade de casos e as áreas de risco em Macapá-AP. MÉTODOS: Estudo ecológico composto por casos de tuberculose registrados no SINAN entre 2001 e 2017. Foi utilizado o teste Prais-Winsten para classificar a tendência temporal da incidência e a Série Temporal Interrompida para identificar mudanças na tendência temporal antes e depois da implementação do teste rápido molecular, além de verificar a sazonalidade no município. Utilizou-se o estimador de Kernel para classificar a densidade de casos e estatística de varredura para identificar áreas de risco da tuberculose. RESULTADOS: Foram identificados 1730 casos, observando-se que a tendência temporal da incidência de tuberculose foi decrescente (-0,27% por mês, IC95% −0,13 a −0,41). Não houve mudança de nível na série temporal após a implantação do teste molecular GeneXpert® MTB/RIF, porém, o período pós teste foi classificado como crescente em termos da incidência (+2,09% por mês, IC95% 0,92 a 3,27). Quanto à variação sazonal, apresentou crescimento (+13,7%/mês, IC95% 4,71 a 23,87) nos meses de dezembro a junho, referente ao período de chuvas – chamado inverno amazônico – e decréscimo (-9,21% por mês, IC95% −1,37 a −16,63) nos demais períodos. Por meio de Kernel, foram classificadas áreas com alta densidade de casos nos distritos Central e Norte e, com a estatística de varredura, foram identificados três aglomerados de proteção, AE1 (RR = 0,07), AE2 (RR = 0,23) e AE3 (RR = 0,36), e um aglomerado de alto risco, AE4 (RR = 1,47). CONCLUSÃO: A tendência temporal da incidência de tuberculose se revelou decrescente na série temporal, todavia, um crescimento na detecção foi observado após introdução do TRM-TB, e ainda se evidenciou que há comportamento sazonal da tuberculose. A distribuição dos casos foi heterogênea, com tendência de concentração em territórios vulneráveis e de risco, evidenciando um padrão de desigualdade da doença no território.

    Abstract in English:

    ABSTRACT OBJECTIVE: To evaluate the temporal trend of tuberculosis incidence after the implementation of the rapid molecular test (RMT-TB), to identify whether tuberculosis presents seasonal variation and to classify the territory according to case density and risk areas in Macapá, Amapá. METHODS: Ecological study of tuberculosis cases registered in the Sistema de Informação de Agravos de Notificação (SINAN – Information System for Notifiable Diseases) between 2001 and 2017. We used the Prais-Winsten test to classify the temporal trend of incidence and the interrupted time series to identify changes in the temporal trend before and after the implementation of the rapid molecular test, and to verify seasonality in the municipality. The Kernel estimator was used to classify case density and scan statistics to identify areas of tuberculosis risk. RESULTS: A total of 1,730 cases were identified, with a decreasing temporal trend of tuberculosis incidence (−0.27% per month, 95%CI −0.13 to −0.41). The time series showed no change in level after the implementation of the GeneXpert®MTB/RIF molecular test; however, the incidence increased in the post-test period (+2.09% per month, 95%CI 0.92 to 3.27). Regarding the seasonal variation, it showed growth (+13.7%/month, 95%CI 4.71 to 23.87) from December to June, the rainy season – called amazon winter season –, and decrease (−9.21% per month, CI95% −1.37 to −16.63) in the other periods. We classified areas with high density of cases in the Central and Northern districts using Kernel and identified three protection clusters, SC1 (RR = 0.07), SC2 (RR = 0.23) and SC3 (RR = 0.36), and a high-risk cluster, SC4 (RR = 1.47), with the scan statistics. CONCLUSION: The temporal trend of tuberculosis incidence was decreasing in the time series; however, detection increased after the introduction of RMT-TB, and tuberculosis showed seasonal behavior. The case distribution was heterogeneous, with a tendency to concentrate in vulnerable and risk territories, evidencing a pattern of disease inequality in the territory.
  • Deaths and hospitalizations resulting from poisoning by prescription and over-the-counter drugs in Brazil Original Article

    Duarte, Fernanda Gross; Paula, Marcelo Neubauer de; Vianna, Nelzair Araújo; Almeida, Maria Conceição Chagas de; Moreira Junior, Edson Duarte

    Abstract in Portuguese:

    RESUMO OBJETIVO: Estimar a incidência de hospitalizações por intoxicação medicamentosa e a mortalidade desses agravos no Brasil, descrevendo as tendências de 2009 a 2018. MÉTODOS: Os dados de internações hospitalares e óbitos originam-se do DATASUS e os dados demográficos, do Instituto Brasileiro de Geografia e Estatística (IBGE). Foram selecionadas as internações hospitalares cuja Autorização para Internação Hospitalar (AIH) indicasse como procedimento “tratamento de intoxicação ou envenenamento por exposição a medicamento e substâncias de uso não medicamentoso”, sendo analisados apenas os casos de hospitalização por intoxicação medicamentosa. A incidência de hospitalização e a mortalidade foram calculadas separadamente para intoxicações causadas por medicamentos com prescrição (MRx) e isentos de prescrição (MIP). As taxas foram ainda estratificadas por sexo, faixa etária e região de residência no Brasil. A análise de tendência foi realizada por regressão linear generalizada pelo método de Prais-Winsten. RESULTADOS: A maioria das internações foi causada por MRx (97%), com mortalidade aproximadamente 50 vezes maior, quando comparada às internações por MIP. A tendência da incidência das internações por MRx foi estacionária, mas a mortalidade aumentou durante o período estudado, enquanto a tendência na mortalidade e na incidência de internações por MIP foi decrescente. CONCLUSÕES: As internações por intoxicação medicamentosa, sobretudo aquelas causadas por MRx, têm grande impacto e importância na saúde pública, especialmente porque esses agravos podem ser prevenidos.

    Abstract in English:

    ABSTRACT OBJECTIVE: To estimate the incidence of hospitalizations considering drug intoxication and the mortality of these diseases in Brazil, given trends from 2009 to 2018. METHODS: Data on hospital admissions and deaths come from DATASUS and demographic data from the Brazilian Institute of Geography and Statistics (IBGE). Hospital admissions with Autorização para Internação Hospitalar (AIH - Authorization for Hospital Admission) indicated as a procedure “treatment of intoxication or poisoning due to exposure to drugs and substances for non-drug use” were selected, with only cases of hospitalization due to drug intoxication being analyzed. The incidence of hospitalization and mortality were calculated separately for intoxications caused by medicamentos com prescrição (MRx - prescription drugs) and medicamentos isentos de prescrição (MIP - over-the-counter drugs). Rates were further stratified by sex, age group, and region of residence in Brazil. Trend analysis was performed by generalized linear regression using the Prais-Winsten method. RESULTS: MRx caused most hospitalizations (97%), with mortality approximately 50 times higher when compared to hospitalizations for MIP. The incidence trend in hospitalizations for MRx was stationary and mortality increased during the study period, whereas the trend in mortality and in the incidence of hospitalizations for MIP decreased. CONCLUSIONS: Hospitalizations for drug intoxication, especially those caused by MRx, have a great impact and importance on public health considering that prevention is possible.
  • Spatial and spatio-temporal distribution of women living with HIV mortality in Porto Alegre, Brazil, from 2007 to 2017 Original Article

    Bernardelli, Maiton; Gonçalves, Tonantzin Ribeiro; Pattussi, Marcos Pascoal; Barcellos, Nêmora Tregnago; Acosta, Lisiane

    Abstract in Portuguese:

    RESUMO OBJETIVO: Apresentar fatores associados à taxa de óbitos de mulheres vivendo com HIV (MVHIV) na cidade de Porto Alegre-RS. MÉTODOS: Estudo ecológico de análise espacial e espaço temporal incluindo todas as mulheres acompanhadas nos serviços de atenção à transmissão vertical (TV) do HIV, entre 2007 e 2017, residentes no município e que faleceram nesse período. As unidades de análise foram os 17 distritos sanitários do município. A variável dependente foi a taxa de óbito e as independentes territoriais foram os indicadores de vulnerabilidade à pobreza, proporção de mulheres chefe de família, escassez de infraestrutura, IDH e o índice de GINI, já as advindas da informação individual foram: idade, raça/cor, escolaridade, tempo de diagnóstico HIV. As análises utilizaram o SPSS 20.0 e o QGIS 218.15. RESULTADOS: Taxas mais elevadas de óbito de MVHIV foram registradas nas regiões com maior vulnerabilidade à pobreza e precariedade na infraestrutura local, associadas ao desfecho em mulheres em idade fértil, pretas/pardas e de baixa escolaridade. Nas regiões com altas taxas de mulheres que chefiam a família, a prevalência de óbito foi sete vezes maior, mesmo resultado obtido com a proporção populacional de vulnerabilidade à pobreza. CONCLUSÕES: As regiões que apresentam indicadores de vulnerabilidade críticos resultaram em taxas mais elevadas de óbito em MVHIV, revelando o impacto das desigualdades sociais em saúde para a morte dessas mulheres.

    Abstract in English:

    ABSTRACT OBJETIVE: To present some factors related to the mortality rates of WLHIV in the city of Porto Alegre-RS. METHODS: This is a spatial and spatio-temporal analysis of ecological data about all women monitored by the health care services for the vertical transmission (VT) of HIV, between 2007 and 2017, residing in the city that died during the period. The units of analysis were the 17 sanitary districts of the city. The dependent variable was the mortality rate. The independent territorial variables were the indicators of vulnerability to poverty, women householder proportion, lack of infrastructure, HDI, and GINI index. Still, the individual data collected were: age, race/color, level of education, and period since the HIV diagnosis. The analyses used SPSS 20.0, and QGIS 218.15. RESULTS: Regions with higher vulnerability to poverty and precarious local infrastructure registered higher WLHIV mortality rates, especially black/”pardo” women in fertile age with low education. The regions with most women householders presented a risk of mortality seven times higher. The population with vulnerability to poverty presented the same result. CONCLUSIONS: Regions with critical indicators of vulnerability presented higher mortality rates of WLHIV, which demonstrates social inequalities’ impact for these women.
  • Admission of alumni from Multiprofessional Residency Programs into the SUS Original Article

    Flor, Taiana Brito Menêzes; Miranda, Nirond Moura; Marinho, Cristiane da Silva Ramos; Pinheiro, Josilene Maria Ferreira; Sette-de-Souza, Pedro Henrique; Noro, Luiz Roberto Augusto

    Abstract in Portuguese:

    RESUMO INTRODUÇÃO: Os Programas de Residência Multiprofissional em Saúde (PRMS) configuram-se como estratégia para a formação de força de trabalho para o Sistema Único de Saúde (SUS). OBJETIVO: Investigar a proporção de egressos de PRMS voltados à Atenção Primária à Saúde (APS) inseridos no SUS e fatores associados. MÉTODOS: Trata-se de um estudo seccional desenvolvido com egressos de PRMS voltados à APS de todo o Brasil, referente ao período de 2015 a 2019. Os participantes responderam a um questionário on-line com informações pessoais gerais, inserção na pós-graduação stricto sensu, no mercado de trabalho e especificamente no SUS. Foram aplicados o teste qui-quadrado de Pearson, para análises bivariadas, e Regressão de Poisson, para a análise múltipla. RESULTADOS: Participaram do estudo 365 egressos de Programas de todas as regiões brasileiras. Destes, 80,2% relataram inserção no mercado de trabalho e 47,9% informaram estar trabalhando no SUS. A inserção no SUS esteve associada às profissões que compõem a Equipe de Referência para a APS (RP = 1,87; IC95% 1,54–2,28) e à não inserção em programas de pós-graduação stricto sensu (RP = 0,77; IC95% 0,61–0,97). Quanto às características de inserção, prevaleceram o cenário da APS (47,4%) e o trabalho voltado à atenção à saúde (84,9%). Quase 40% dos egressos inseridos no SUS estão trabalhando por intermédio de vínculos instáveis, além de frequente não valorização do título da residência no recrutamento (56,9%). Entre os inseridos no SUS, 8,7% relataram terem sido selecionados para o enfrentamento da pandemia de covid-19. CONCLUSÕES: Os resultados deste estudo reforçaram a necessidade de política de incentivo à manutenção, criação e valorização dos PRMS e alertaram para possível aumento da dificuldade de inserção das categorias profissionais, frente ao cenário de desfinanciamento da saúde.

    Abstract in English:

    ABSTRACT INTRODUCTION: The Multiprofessional Health Residency Programs (PRMS) were set up as a strategy for training workforce for the Brazilian Unified Health System (SUS). OBJECTIVE: To investigate the proportion of alumni from Primary Health Care Multiprofessional Residency Programs admitted into the SUS and associated factors. METHODS: This is a sectional study developed with alumni from Primary Health Care Multiprofessional Residency Programs from all over Brazil, encompassing the period from 2015 to 2019. Participants answered an online questionnaire with general personal information, admission into stricto sensu graduate school, the labor market and, specifically, the SUS. We applied Pearson's chi-square test for bivariate analyses and Poisson's regression for multiple analysis. RESULTS: A total of 365 alumni from Programs from all Brazilian regions participated in the study. Of those, 80.2% reported entry into the labor market and 47.9% reported being employed in the SUS. Admission into the SUS has been associated with the professions that make up the Reference Team for Primary Health Care (PHC) (PR = 1.87; 95% CI 1.54–2.28) and non-admission into stricto sensu graduate programs (PR = 0.77; 95% CI 0.61–0.97). Regarding admission characteristics, the PHC scenario (47.4%) and work focused on health care (84.9%) were prevalent. Almost 40% of alumni who entered the SUS are working with unstable contracts. Besides, being a residency alumnus is often undervalued in recruitment (56.9%). Among those admitted into the SUS, 8.7% reported being selected to work in the Covid-19 pandemic effort. CONCLUSIONS: The results of this study reinforce the need for a policy to encourage the maintenance, creation and valorization of the PRMS. They also warn about the possibility that admission into the SUS for workers is increasingly difficult due to the current underfunding of the health system.
  • Carbon footprint of the Brazilian diet Original Article

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

    Abstract in Portuguese:

    RESUMO OBJETIVO: Estimar a pegada de carbono da dieta brasileira e de estratos sociodemográficos dessa população. MÉTODOS: A pegada de carbono da dieta foi estimada com base nos dados de dois registros alimentares de 24 horas, obtidos em 2008 e 2009, de uma amostra probabilística da população brasileira com 10 ou mais anos de idade (n = 34.003) e em coeficientes de impacto ambiental de alimentos e preparações culinárias consumidos no Brasil (gCO2e/kg). Médias com intervalos de confiança de 95% do consumo alimentar (kcal/pessoa/dia) e da pegada de carbono da dieta (gCO2e/pessoa/dia e em gCO2e/2.000kcal) foram calculadas para o conjunto da população e para estratos segundo sexo, idade, renda, escolaridade, macrorregiões e Unidade Federativa. Modelos de regressão linear foram utilizados para identificar diferenças significativas (p < 0,05) na pegada de carbono da dieta de diferentes estratos sociodemográficos. RESULTADOS: A pegada média de carbono da dieta brasileira foi de 4.489gCO2e/pessoa/dia. Foi maior para o sexo masculino, para a faixa etária de 20 a 49 anos e para as regiões Norte e Centro-Oeste, e tendeu a aumentar com a renda e a escolaridade. O padrão de associação da pegada a variáveis sociodemográficas não se alterou substancialmente com o ajuste para diferenças na quantidade consumida de alimentos, exceto por uma redução no excesso relativo da pegada entre homens e pelo aumento no excesso relativo da pegada na região Centro-Oeste. CONCLUSÃO: A pegada de carbono da dieta brasileira excede em cerca de 30% a pegada da dieta humana que poderia atender, simultaneamente, os requisitos nutricionais de uma dieta saudável e a meta global de contenção do aumento da temperatura média do planeta. O padrão de associação dessa pegada às variáveis sociodemográficas pode auxiliar na identificação de alvos prioritários para ações públicas que visem a reduzir os impactos ambientais do consumo alimentar no Brasil.

    Abstract in English:

    ABSTRACT OBJECTIVE: To estimate the carbon footprint of the Brazilian diet and of sociodemographic strata of this population. METHODS: Carbon footprint of the diet was estimated based on data from two 24-hour diet records, obtained in 2008 and 2009, from a probabilistic sample of the Brazilian population aged 10 years and over (n = 34,003) and on environmental impact coefficients of food and culinary preparations consumed in Brazil (gCO2e/kg). Means with 95% confidence intervals of food consumption (kcal/person/day) and the carbon footprint of the diet (gCO2e/person/day and in gCO2e/2,000kcal) were calculated for the population as a whole and for strata according to sex, age, income, education, macro-regions and Federative Unit. Linear regression models were used to identify significant differences (p < 0.05) in the dietary carbon footprint of different sociodemographic strata. RESULTS: The average carbon footprint of the Brazilian diet was 4,489gCO2e/person/day. It was higher for males, for the age group from 20 to 49 years and for the North and Midwest regions, and tended to increase with income and education. The pattern of association of footprint with sociodemographic variables did not change substantially with adjustment for differences in the amount of food consumed, except for a reduction in the relative excess of the footprint among males and an increase in the relative excess of the footprint in the Midwest region. CONCLUSION: The carbon footprint of the Brazilian diet exceeds by about 30% the footprint of the human diet, which could simultaneously meet the nutritional requirements of a healthy diet and the global goal of containing the increase in the planet's average temperature. The pattern of association of this footprint with sociodemographic variables can help identify priority targets for public actions aimed at reducing the environmental impacts of food consumption in Brazil.
  • Drivers of federal spending in pharmaceuticals of the Specialized Component: measurement and analysis Original Article

    Vieira, Fabiola Sulpino

    Abstract in Portuguese:

    RESUMO OBJETIVOS: Quantificar e analisar a contribuição dos indutores principais do gasto federal na aquisição de medicamentos do Componente Especializado da Assistência Farmacêutica (CEAF) no período de 2010 a 2019. MÉTODOS: Realizou-se análise de decomposição do gasto anual do Ministério da Saúde (MS) em medicamentos do grupo 1A do CEAF a fim de isolar a contribuição dos seus indutores principais, preço, quantidade e resíduo, que envolve as escolhas terapêuticas. A quantificação dessa contribuição foi feita com o suporte do software RStudio versão 1.3.1056 e do pacote estatístico IndexNumR. RESULTADOS: O principal indutor do aumento do gasto entre 2011 e 2018 foi a quantidade dos medicamentos sobrepostos, 55% e 34%. Por sua vez, o indutor principal em 2013 e 2015 foi o resíduo, 33,2% e 57,9%. Entretanto, o gasto em 2019 registrou queda de 30,4% em relação a 2010. Houve diminuição dos preços dos tratamentos diários em todo o período. Entre os anos em que houve redução do gasto, o resíduo foi o principal indutor da queda em 2012 (-19,6%) e 2019 (-11,9%), enquanto os preços tiveram maior impacto na diminuição do gasto em 2014 (-12%). Houve ainda redução da quantidade dos medicamentos sobrepostos em três anos consecutivos, sendo -11% em 2015, -4% em 2016 e -11% em 2017. Por fim, em 2019 a redução foi de -4%. CONCLUSÕES: A contribuição dos indutores para o gasto do MS no grupo 1A do CEAF oscilou entre 2010 e 2019. Entretanto, a queda do gasto em anos recentes foi induzida pelos três indutores principais: preço, quantidade e resíduo. A diminuição da quantidade adquirida pode ter reduzido a disponibilidade de alguns medicamentos no Sistema Único de Saúde (SUS).

    Abstract in English:

    ABSTRACT OBJECTIVES: Quantify and analyze the contribution of the main drivers of federal spending in pharmaceuticals purchase from the Specialized Component of Pharmaceutical Care (CEAF) in the period from 2010 to 2019. METHODS: An analysis of the annual expenditure's decomposition of the Brazilian Ministry of Health (MS) in pharmaceuticals from group 1A of the CEAF was carried out in order to isolate the contribution of its main drivers, price, quantity and residual, which involves therapeutic choices. This contribution's quantification was made with the support of the RStudio software version 1.3.1056 and the IndexNumR statistical package. RESULTS: The main driver of increased expenditure between 2011 and 2018 was the quantity of overlapping pharmaceuticals, 55% and 34%. In turn, the main driver in 2013 and 2015 was the residual, 33.2% and 57.9%. However, the expenditure in 2019 decreased by 30.4% compared with 2010. There was a decrease in the prices of daily treatments throughout the period. Among the years in which there was a reduction in expenditure, the residual was the main driver of the decrease in 2012 (-19.6%) and 2019 (-11.9%), while prices had the greatest impact on the decrease in expenditure in 2014 (-12%). There was also a reduction in the quantity of overlapping pharmaceuticals in three consecutive years, being -11% in 2015, -4% in 2016 and -11% in 2017. Lastly, in 2019 the reduction was -4%. CONCLUSIONS: The contribution of drivers to MS expenditure in the CEAF's 1A group fluctuated between 2010 and 2019. However, the expenditure decrease in recent years was induced by the three main drivers: price, quantity and residual. The decrease in the quantity purchased may have reduced the availability of some pharmaceuticals in the Brazilian Unified Health System (SUS).
  • Effect of the coverage of rapid tests for syphilis in primary care on the syphilis in pregnancy in Brazil Original Article

    Roncalli, Angelo Giuseppe; Rosendo, Tatyana Maria Silva de Souza; Santos, Marquiony Marques dos; Lopes, Ana Karla Bezerra; Lima, Kenio Costa de

    Abstract in Portuguese:

    RESUMO OBJETIVO: Analisar o efeito da cobertura de testes rápidos na Atenção Básica sobre a taxa de detecção de sífilis em gestantes no Brasil, nos municípios com mais de 100 mil habitantes. MÉTODOS: A variável dependente foi a taxa de detecção de sífilis em gestantes entre os anos de 2012 e 2018. Como variáveis independentes principais, foram utilizados os métodos de aferição da cobertura de testes rápidos para sífilis na Atenção Básica e, como variáveis de ajuste, alguns indicadores de serviços de saúde e socioeconômicos. Optou-se por um modelo de regressão linear para dados em painel (panel data analysis), considerando o município como unidade de análise e ano como variável de tempo. RESULTADOS: Pelos resultados do modelo final, pode-se inferir que, para um determinado município, à medida que a taxa de testes rápidos aumenta em um ponto para cada mil nascidos vivos, a taxa de detecção de sífilis em gestantes aumenta em média 0,02 casos por mil nascidos vivos (p < 0,001). Esse valor está ajustado para cobertura de Saúde da Família, proporção de UBS por habitante, gastos per capita com saúde e Índice de Desenvolvimento Humano. CONCLUSÕES: Houve uma melhora substancial na quantidade de testes rápidos disponíveis, bem como, o aumento significativo de realização desses testes em gestantes, o que prediz o aumento das taxas de sífilis em gestantes. Contudo, uma hipótese preocupante é que a quantidade de testes realizados em gestantes no período analisado pode ter sido insuficiente para detectar o avanço da epidemia nessa população.

    Abstract in English:

    ABSTRACT OBJECTIVE: To analyze the effect of rapid tests coverage in Primary Care on syphilis detection rate in pregnant women in Brazil, in municipalities with more than 100,000 inhabitants. METHODS: The dependent variable was the syphilis detection rate in pregnant women between 2012 and 2018. As the main independent variables, the methods for measuring the coverage of rapid tests for syphilis in Primary Care were used and, as adjustment variables, some indicators of health services and socioeconomic. We opted for a linear regression model for panel data (panel data analysis), considering the municipality as the unit of analysis and the year as the time variable. RESULTS: From the results of the final model, we can infer that, for a given municipality, as the rate of rapid tests increases by one point for every thousand live births, the detection rate of syphilis in pregnant women increases by an average of 0.02 cases per thousand live births (p < 0.001). This value is adjusted for Family Health coverage, proportion of health facilities per inhabitant, per capita expenditure on health and the Human Development Index. CONCLUSIONS: There was a substantial improvement in the amount of rapid tests available, as well as a significant increase in the number of tests performed in pregnant women, which predicts an increase in syphilis rates in pregnant women. However, a worrying hypothesis is that the number of tests performed on pregnant women during the analyzed period may have been insufficient to detect the progress of the epidemic in this population.
  • Family and contextual factors associated with licit drug use in adolescence Original Article

    Gomes, Monalisa Cesarino; Granville-Garcia, Ana Flávia; Neves, Erick Tássio Barbosa; Dutra, Laio da Costa; Ferreira, Fernanda Morais; Paiva, Saul Martins

    Abstract in English:

    ABSTRACT OBJECTIVE: TO evaluate the family and contextual factors associated with licit drug use among 15 to 19-year-old adolescents in the school context. METHODS: This is a representative, school-based, cross-sectional study conducted with 746 adolescents from 15 to 19 years old enrolled in public and private schools. Parents/guardians reported on the sociodemographic variables, while adolescents answered questionnaires on drug use, family cohesion and adaptability, oral health literacy and visits to the dentist. Information on school context was obtained at the institution and via municipal publications. Associations between variables were analyzed using unadjusted and adjusted multilevel Poisson regression models. RESULTS: Prevalence of licit drug use at least once and a pattern indicative of harmful drug use were 39.8% and 15.1%, respectively. After the adjusted analysis of licit drug use at least once, the variables gender (PR = 1.26; 95%CI: 1.01–1.59), family cohesion (PR = 9.81; 95%CI: 1.23–72.54), and average income of the school district (PR = 0.72; 95%CI: 0.57–0.91) remained in the final model. As for drug abuse, only the detached type (PR = 23.01; 95%CI: 2.46–214.87) and separated type (PR = 13.54; 95%CI: 1.40–130.97) of family cohesion remained in the final model. CONCLUSION: Experience with licit drug use was associated with family and contextual factors among the adolescents, while family cohesion was the main factor related to harmful drug use.
  • Why does mental health care not follow the structuring of primary care? Original Article

    Lima, Antonio Moacir de Jesus; Andrade, Eli Iola Gurgel; Machado, Antonio Thomaz Gonzaga da Matta; Santos, Alainer de Fátima dos

    Abstract in Portuguese:

    RESUMO OBJETIVO: Verificar se equipes de atenção básica que possuem atributos mais bem estruturados da atenção primária à saúde (APS) conseguem oferecer melhor assistência em saúde mental (SM). MÉTODOS: Estudo transversal realizado a partir dos dados da avaliação externa do segundo ciclo do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB), envolvendo 31.587 equipes de atenção básica, entre 2013 e 2014. Foram construídas duas tipologias: qualidade da assistência em saúde mental (variável dependente) e estruturação da APS segundo atributos essenciais (variável independente). Para a construção da tipologia de saúde mental, foram identificados conteúdos sobre o tema no módulo II do PMAQ e realizados somatórios das perguntas para a categorização dos índices. Para a estruturação da APS segundo atributos, utilizou-se técnica Delphi para consensualidade em quatro rodadas referendadas por especialistas. Com análises de regressão logística multinomial, verificou-se associação entre as tipologias e identificou-se qual atributo mais contribuía para qualidade da atenção em saúde mental. RESULTADOS: Verificou-se que 29,2% das equipes encontram-se em um nível baixo de qualidade em assistência à SM, enquanto 7,5% das equipes apresentam um nível baixo de estruturação da APS segundo atributos essenciais. Diferenças regionais são mantidas, tanto para estruturação da APS quanto para a qualidade da assistência à saúde mental. Evidenciou-se uma chance maior de realizar uma assistência em SM com melhor qualidade quando a APS está mais bem estruturada em nível alto (OR = 14,74) e em nível médio (OR = 2,193). Alto nível de Integralidade está associado a alto nível de Qualidade da Assistência em SM (OR = 3,21). CONCLUSÕES: Os resultados indicam que há predomínio de baixos níveis de qualidade da assistência à saúde mental, em descompasso com o processo de estruturação da APS, considerando seus atributos essenciais.

    Abstract in English:

    ABSTRACT OBJECTIVE: To verify if primary care teams with better structured primary health care (PHC) attributes could offer better mental health (MH) care. METHODS: Cross-sectional study based on data from the external evaluation of the second cycle of the Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB - Access and Quality Improvement of Primary Care Program), involving 31,587 primary care teams, between 2013 and 2014. Two typologies were built: quality of mental health care (dependent variable) and PHC structuring according to essential attributes (independent variable). We identified some contents for the construction of the mental health typology (module II of the PMAQ) and performed sums of questions for the categorization of indices. The Delphi technique rendered consensus in four rounds endorsed by experts, following the attributes of PHC structure. Multinomial logistic regression analyses verified the association between the typologies and identified which attribute most contributed to the quality of mental health care. RESULTS: We found out that 29.2% of the teams are at low levels of quality in assistance to MH, while 7.5% of the teams have a low level of structuring the PHC according to essential attributes. Regional differences are maintained, both for the structuring of the PHC and for the quality of mental health care. There was a greater chance of providing care in MH with better quality when the PHC is better structured at a high level (OR = 14.74) and at a medium level (OR = 2.193). A high level of completeness is associated with a high level of Quality of Care in MH (OR = 3.21). CONCLUSION: results indicate a predominance of low levels of quality in mental health care, out of step with the process of PHC structuring and its essential attributes.
  • Trajectories of family and employment stress associated with cerebrovascular accidents Original Article

    Jerez, María Pilar; Madero-Cabib, Ignacio

    Abstract in Spanish:

    RESUMEN OBJETIVOS: Reconstruir tipos de trayectorias de estrés simultáneo en el dominio familiar y laboral en diferentes etapas de la vida y estimar su asociación con accidentes cerebrovasculares (ACV) en la vejez. MÉTODOS: Se utilizó una encuesta retrospectiva, cara a cara, y representativa de personas de 65 a 75 años en la ciudad de Santiago de Chile (n = 802). Se empleó un análisis de secuencias multicanal para reconstruir tipos de trayectorias de estrés familiar y laboral en diversas etapas de la vida y luego se utilizaron modelos de regresión logística para estimar la asociación de estos tipos de trayectoria con ACV en la vejez, controlado por factores tradicionales de riesgo cardiovascular. RESULTADOS: Se identificaron cuatro tipos representativos de trayectorias de estrés familiar y laboral: (1) Ausencia de estrés familiar y laboral, (2) Ausencia de estrés familiar, estrés laboral persistente, (3) Ausencia de estrés familiar, fuera de mercado laboral, y (4) Estrés familiar persistente, ausencia de estrés laboral. El 61,7% de la muestra siguió trayectorias marcadas por la presencia permanente de estrés familiar y/o laboral. Asimismo, el 18,3% tuvo una trayectoria caracterizada por la ausencia prolongada del mercado del trabajo. Las personas con trayectorias de estrés familiar o laboral persistente, así como aquellas con períodos extensos de inactividad, tienen más riesgo de desarrollar ACV. CONCLUSIONES: El estrés es un factor de riesgo de enfermedades cardiovasculares que experimenta de manera prolongada muchas personas en distintas etapas y dominios de la vida. En consecuencia, los sistemas de prevención de este tipo de enfermedades crónicas deben enfatizar los efectos altamente nocivos de enfrentar cotidiana y acumulativamente experiencias de vida estresantes. Esto a su vez podría mitigar las múltiples consecuencias sanitarias y financieras asociadas al ACV.

    Abstract in English:

    ABSTRACT OBJECTIVES: Reconstruct types of simultaneous stress trajectories in the family and employment domain at different stages of life and estimate their association with cerebrovascular accident (CVA) in old age. METHODS: We used a retrospective, face-to-face, representative survey of people aged 65 to 75 years in the city of Santiago, Chile, (n = 802). We performed a multichannel sequence analysis to reconstruct family and employment stress trajectory types at various life stages and then used logistic regression models to estimate the association of these trajectory types with CVA in old age, controlled for traditional cardiovascular risk factors. RESULTS: Four representative types of family and employment stress trajectories were identified: (1) Absence of family and employment stress, (2) Absence of family stress, persistent employment stress, (3) Absence of family stress, out of the labor market, and (4) Persistent family stress, absence of employment stress. The 61.7% of the sample followed trajectories marked by the permanent presence of family and/or employment stress. Likewise, 18.3% had a trajectory characterized by prolonged absence from the labor market. Individuals with persistent family or employment stress trajectories, as well as those with extended periods of inactivity, are more at risk of developing CVA. CONCLUSIONS: Stress is a risk factor for cardiovascular disease experienced by many people at different stages and domains of life on a prolonged basis. Consequently, prevention systems for this type of chronic diseases should emphasize the highly harmful effects of daily and cumulatively stressful life experiences. This could mitigate the multiple health and financial consequences associated with CVA.
  • Laboratory chemical waste: hazard classification by GHS and transport risk Original Article

    Giovanni, Cássio; Marques, Fabio Luiz Navarro; Günther, Wanda Maria Risso

    Abstract in Portuguese:

    RESUMO OBJETIVOS: Identificar e avaliar, com base no Sistema Globalmente Harmonizado de Classificação e Rotulagem de Produtos Químicos (GHS) e na legislação da Agência Nacional de Transportes Terrestres (ANTT), os perigos provenientes dos resíduos químicos gerados em laboratórios de pesquisa na área de saúde. MÉTODOS: Resíduos químicos gerados em dois Laboratórios de Investigação Médica da Faculdade de Medicina da Universidade de São Paulo foram inventariados, no período de novembro de 2017 a abril de 2019, e classificados conforme o GHS (frases de perigo) e a legislação de transportes da ANTT (classes de risco), para determinação dos perigos provenientes das respectivas substâncias e misturas. RESULTADOS: No total, foram identificadas 40 substâncias ou misturas, cuja classificação pelo GHS indicou 36 frases de perigo, sendo 27 relacionadas à saúde humana. De acordo com a legislação estabelecida pela ANTT, foram encontrados 16 casos de periculosidade associada à inflamabilidade, 15 casos relacionados à toxicidade e 12 casos relativos à corrosividade. CONCLUSÕES: Resíduos químicos gerados nos laboratórios estudados são diversificados quanto a suas características de periculosidade, implicando a possibilidade de exposição a riscos severos aos trabalhadores, aos estudantes e ao ambiente. A correta identificação desses resíduos é fator primordial para diminuição da exposição aos riscos.

    Abstract in English:

    ABSTRACT OBJECTIVES: To identify and evaluate, based on the Globally Harmonized System of Classification and Labelling of Chemicals (GHS) and the legislation of the Agência Nacional de Transportes Terrestres (ANTT – National Agency for Terrestrial Transport), the hazards arising from chemical waste generated in research laboratories in the health area. METHODS: Chemical residues generated in two medical research laboratories of the Faculdade de Medicina da Universidade de São Paulo were inventoried, from November 2017 to April 2019, and classified according to the GHS (hazard statements) and the ANTT transport legislation (risk classes), to determine the dangers coming from the respective substances and mixtures. RESULTS: In total, we identified 40 substances or mixtures with classification by the GHS indicating 36 hazard statements, 27 of which related to human health. According to the legislation established by ANTT, we found 16 cases of hazard associated with flammability, 15 cases related to toxicity and 12 cases related to corrosivity. CONCLUSIONS: Chemical residues generated in the laboratories studied are diversified in terms of their hazard characteristics, implying the possibility of exposure to severe risks to workers, students and the environment. The correct identification of these residues is a primary factor for reducing exposure to risks.
  • Attitude and perception towards vaccination against poliomyelitis in Peshawar, Pakistan Original Article

    Shafique, Farheen; Hassan, Mahreen ul; Nayab, Hina; Asim, Noreen; Akbar, Nazia; Shafi, Nuzhat; Manzoor, Sadaf; Eeden, Freek van; Ali, Shaukat

    Abstract in English:

    ABSTRACT OBJECTIVE: This research aimed to quantitatively assess the general public's awareness, attitude and perception of polio and its vaccination in Peshawar KPK, Pakistan. METHODS: We conducted a survey-based study to understand the surge in polio cases from 2015 to 2019 in the Peshawar city of the Khyber Pakhtunkhwa (KPK), Pakistan. A pre-tested questionnaire-based study was conducted in 2019 to assess the attitude and general perception of residents of Peshawar KPK towards polio vaccination. RESULTS: Out of 241 country-wide polio cases, 63 (26.1%) polio cases were reported in Peshawar city from 2015–2019. The questionnaire revealed that individuals between 18–30 years of age had sufficient knowledge (65.1%) about polio. Male and female participants had equal awareness (~ 43%). Participants with higher education (45.9%), those with better financial status (49.5%), individuals with children < 5 years of age (46.4%), and those who had experience of a polio patient (63.1%) had better knowledge. Participants inhabiting the central city were better aware (50.5%) of polio than individuals living in the outskirts. CONCLUSION: The data indicated that poor knowledge and negative attitudes of people towards polio vaccination are the main causes of the polio eradication program's failure. Moreover, religious beliefs, unchecked migration between the Pak-Afghan border, and lack of knowledge about polio vaccination are identified as critical barriers to polio eradication.
  • Male condom and dual protection use by adolescent men in Brazil Original Article

    Borges, Ana Luiza Vilela; Duarte, Luciane Simões; Cabral, Cristiane da Silva; Lay, Alejandra Andrea Roman; Viana, Osmara Alves; Fujimori, Elizabeth

    Abstract in Portuguese:

    RESUMO OBJETIVO: Analisar o uso de preservativo masculino e de dupla proteção por homens adolescentes brasileiros, bem como os aspectos associados. MÉTODOS: Utilizou-se banco de dados do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA) para este estudo transversal nacional de base escolar. A amostra incluiu adolescentes de ambos os sexos, com idades entre 12 e 17 anos de idade, selecionados por meio de amostragem por conglomerados, em 2014 (n = 75.060). O presente estudo analisou informações dos homens adolescentes que relataram já ter tido relação sexual (n = 12.215), tendo como variáveis dependentes o uso de preservativo masculino e o uso de dupla proteção (uso simultâneo de preservativo masculino e contraceptivo hormonal oral) na última relação sexual. Os dados foram analisados por meio de regressão logística univariada e múltipla. RESULTADOS: A maior parte dos adolescentes usou preservativo masculino na última relação sexual, enquanto o uso de dupla proteção foi bastante baixo. O uso de preservativo masculino, referido por 71% (IC95% 68,7–73,1), associou-se positivamente à idade, a coabitar com ambos os pais e a ter usado álcool nos 30 dias anteriores. O uso de dupla proteção, referido por 3,6% (IC95% 2,8–4,5) associou-se positivamente à idade e a estudar em escola privada e negativamente ao uso de tabaco nos 30 dias anteriores. CONCLUSÕES: A larga diferença apresentada na proporção de uso de preservativo ou de dupla proteção na última relação sexual chama atenção para as distintas lógicas que presidem as relações sexuais juvenis. A baixa proporção aqui encontrada de uso da dupla proteção pode ser reflexo do desconhecimento masculino sobre uma função que tem sido historicamente atribuída às mulheres, que é a contracepção. Dessa forma, é necessário desconstruir a dicotomia de que a esfera da sexualidade é de domínio/interesse dos homens enquanto a da reprodução concerne apenas às mulheres.

    Abstract in English:

    ABSTRACT OBJECTIVE: To assess the use of male condoms and dual protection by Brazilian adolescent men, as well as their associated aspects. METHODS: A database from the Study of Cardiovascular Risks in Adolescents (ERICA) was used for this national cross-sectiotabelnal school-based research. The sample included adolescents of both sexes, aged between 12 and 17 years old, selected through cluster sampling in 2014 (n = 75,060). This study analyzed information from adolescent men who reported having had sexual intercourse (n = 12,215). The dependent variables were the use of male condoms and the use of dual protection (simultaneous use of male condoms and oral hormonal contraceptives) in the last sexual intercourse. Data were analyzed using univariate and multiple logistic regression. RESULTS: Most adolescents used a male condom in the last sexual intercourse, while the use of double protection was quite low. The use of male condoms, reported by 71% (95%CI 68.7–73.1), was positively associated with age, living with both parents, and having used alcohol in the previous 30 days. The use of double protection, reported by 3.6% (95%CI 2.8–4.5) was positively associated with age and studying in a private school, as well as negatively associated with tobacco use in the previous 30 days. CONCLUSIONS: The wide difference shown in the proportion of condom or dual protection use in the last sexual intercourse draws attention to the different logics that govern juvenile sexual relations. The low proportion of dual protection use may be a reflection of men’s lack of knowledge about a function that has historically been attributed to women, which is contraception. Thus, one must deconstruct such dichotomy that the sphere of sexuality is of the domain/interest of men, while that of reproduction concerns only women.
  • The invisible magnitude of the rape of girls in Brazil Original Article

    Taquette, Stella Regina; Monteiro, Denise Leite Maia; Rodrigues, Nádia Cristina Pinheiro; Ramos, José Augusto Sapienza

    Abstract in Portuguese:

    RESUMO OBJETIVO Comparar dados oficiais notificados de violência sexual contra meninas de 10 a 13 anos com dados sobre gravidez nessa mesma faixa etária entre 2012 e 2018. MÉTODOS estudo epidemiológico, descritivo, de corte transversal, com dados do Departamento de Informática do Sistema Único de Saúde (DATASUS) sobre violência e gestação de meninas com idades entre 10 e 13 anos, dos anos de 2012 a 2018. Os dados sobre violência sexual foram acessados no Sistema de Informação de Agravos de Notificação (SINAN). Os dados sobre gravidez foram buscados em três Sistemas de Informação: o de Nascidos Vivos (SINASC), o de Mortalidade (SIM), para os óbitos fetais e o de Internações hospitalares (SIH), para os de aborto. RESULTADOS No período de 2012 a 2018 houve 136.387 gestações, sendo 120.185 nascimentos e 15.402 gestações interrompidas por aborto ou óbito fetal de mães que engravidaram com 13 anos ou menos. No mesmo período foram notificados ao SINAN 46.548 casos de abuso sexual de meninas com idades entre 10 e 13 anos. O número de meninas que engravidaram antes dos 14 anos, vítimas de estupro de vulnerável, foi 2,9 vezes maior do que o número de casos notificados ao SINAN. CONCLUSÃO A falta de registro adequado do estupro de vulnerável nas estatísticas oficiais no Brasil leva a subestimativa de sua magnitude.

    Abstract in English:

    ABSTRACT OBJECTIVE Compare official data on notifications of sexual violence against girls aged 10 to 13 years with data on pregnancy for the same age group between 2012 and 2018. METHODS This is an epidemiological, descriptive, cross-sectional study with data from the Department of Informatics of the Unified Health System (DATASUS) on violence against and pregnancy of girls aged 10 to 13 years from 2012 to 2018. Data on sexual violence were accessed in the Health Information System (SINAN); on pregnancy, in the Live Births Information System (SINASC), on fetal deaths, in the Mortality Information System (SIM), and on abortions, in the Hospital Admission System (SIH). RESULTS Between 2012 and 2018, out of 136,387 pregnancies, there were 120,185 live births and 15,402 interrupted pregnancies by abortions or fetal deaths of mothers who became pregnant aged 13 years or younger. In the same period, SINAN received 46,548 notifications of sexual abuse against girls aged 10 to 13 years. The number of girls who became pregnant before the age of 14, victims of statutory rape, was 2.9 times higher than the number of cases notified to SINAN. CONCLUSION The lack of adequate notification of statutory rapes in Brazilian official statistics leads to the underestimation of its magnitude.
  • Redistributing deaths by ill-defined and unspecified causes on cancer mortality in Brazil Original Article

    Bigoni, Alessandro; Cunha, Amanda Ramos da; Antunes, José Leopoldo Ferreira

    Abstract in English:

    ABSTRACT OBJECTIVE to discuss the impact four different redistribution strategies have on the quantitative and temporal trends of cancer mortality assessment in Brazil. METHODOLOGY This study used anonymized and georeferenced data provided by the Brazilian Ministry of Health (BMoH). Four different approaches were used to conduct the redistribution of ill-defined deaths and garbage codes. Age-standardized mortality rates used the world population as reference. Prais-Winsten autoregression allowed the calculation of region, sex, and cancer type trends. RESULTS Death rates increased considerably in all regions after redistribution. Overall, Elisabeth B. França’s and the World Health Organization methods had a milder impact on trends and rate magnitudes when compared to the Global Burden of Disease (GBD) 2010 method. This study also observed that, when the BMoH dealt with the problem of redistributing ill-defined deaths, results were similar to those obtained by the GBD method. The redistribution methods also influenced the assessment of trends; however, differences were less pronounced. CONCLUSIONS Since developing a comparative gold standard is impossible, matching global techniques to local realities may be an alternative for methodological selection. In our study, the compatibility of the findings suggests how valid the GBD method is to the Brazilian context. However, caution is needed. Future studies should assess the impact of these methods as applied to the redistribution of deaths to type-specific neoplasms.
  • Occupational stressors and work accidents among health workers Original Article

    Gomes, Mariana Rabelo; Araújo, Tânia Maria de; Soares, Jorgana Fernanda de Souza; Sousa, Camila Carvalho de; Lua, Iracema

    Abstract in Portuguese:

    RESUMO OBJETIVO Testar associação entre estressores ocupacionais e acidentes de trabalho por exposição a material biológico (ATbio) em trabalhadores da saúde, considerando a análise isolada e combinada das dimensões de dois modelos, o modelo demanda-controle (MDC) e o modelo de desequilíbrio esforço-recompensa (ERI). MÉTODOS Estudo de corte transversal em amostra representativa de trabalhadores de nível superior, técnico, médio, incluindo agentes de saúde de unidades da atenção básica e média complexidade em cinco cidades da Bahia. Selecionou-se amostragem aleatória, estratificada por área geográfica, nível de complexidade do serviço e ocupação. A variável desfecho foi ATbio; a exposição principal foram os estressores ocupacionais, avaliados pelo MDC e ERI. As incidências e os riscos relativos foram estimados em função do caráter agudo, de curta duração, do desfecho de interesse. Testaram-se associações entre ATbio e as dimensões do MDC e ERI isolados e combinados. RESULTADOS Participaram do estudo 3.084 trabalhadores. A incidência global de ATbio foi de 3,4% e mostrou-se associada a alta demanda psicológica, alto esforço e alto comprometimento com o trabalho, com ajuste por sexo, idade, escolaridade e turno de trabalho. Trabalho de alta exigência e situação de desequilíbrio entre esforços e recompensas estavam associados aos ATbio. Com a combinação dos modelos, observou-se incremento da medida de associação com o desfecho. As associações significantes e de maior magnitude foram observadas nos modelos combinados completos. O risco de ATbio foi 5,23 vezes maior entre os expostos em ambos os modelos completos em comparação com a ausência de exposição nos dois modelos. CONCLUSÕES Estressores ocupacionais mostraram-se associados aos ATbio. Observaram-se vantagens no uso dos modelos combinados. A abordagem de diferentes dimensões psicossociais ampliou a capacidade de identificação de grupos expostos, oferecendo base sólida para intervenções de prevenção dos ATbio em saúde.

    Abstract in English:

    ABSTRACT OBJECTIVE To test the association between occupational stressors and work accidents due to exposure to biological material (ATbio) in health workers, considering the isolated and combined analysis of the dimensions of two models, the demand-control model (DCM) and the effort-reward imbalance model (ERI). METHODS Cross-sectional study in a representative sample of workers with higher, technical and secondary education, including health agents from primary and medium-complexity care units in five cities in Bahia. Random sampling was selected, stratified by geographic area, level of service complexity and occupation. The outcome variable was ATbio; The main exposure was occupational stressors, assessed by the DCM and ERI. Incidences and relative risks were estimated as a function of the acute, short-term nature of the outcome of interest. Associations between ATbio and isolated and combined DCM and ERI dimensions were tested. RESULTS A total of 3,084 workers participated in the study. The global incidence of ATbio was 3.4% and was associated with high psychological demand, high effort and high commitment to work, adjusted for sex, age, education and work shift. High-strain work and a situation of imbalance between efforts and rewards were associated with ATbio. With the combination of the models, an increase in the measure of association with the outcome was observed. Significant associations of greater magnitude were observed in the complete combined models. ATbio’s risk was 5.23 times higher among those exposed in both complete models compared to the absence of exposure in both models. CONCLUSIONS Occupational stressors were associated with ATbio. Advantages in using the combined models were observed. The approach of different psychosocial dimensions has expanded the ability to identify exposed groups, offering a solid basis for interventions for ATbio’s prevention in health.
  • Evaluation of a support system for health professionals confined by COVID-19 Original Article

    García-Sierra, Rosa; Moreno-Gabriel, Eduard; Badia Perich, Esther; Sabaté Cintas, Victòria; Bonet Simó, Josep M.; Violán, Concepción Fors; Gil, Nuria Prat; Rodríguez, Mònica Piña; Torán-Monserrat, Pere

    Abstract in Spanish:

    RESUMEN OBJETIVOS Evaluar la implementación de un circuito telefónico de apoyo a profesionales sanitarios confinados por COVID-19 en una dirección de Atención Primaria de Barcelona, en España. MÉTODOS Estudio observacional, descriptivo y transversal, realizado con profesionales confinados en domicilio entre el 11 de marzo y el 31 de mayo de 2020. Se envió por correo electrónico un cuestionario con 18 preguntas cerradas y una abierta. Se realizó un análisis descriptivo de las respuestas cerradas y un análisis del contenido temático de la pregunta abierta. RESULTADOS 398 profesionales puntuaron globalmente el circuito con 6,54 en una escala de 1 a 10. El formato de las llamadas realizadas en el circuito de apoyo se estimó con las puntuaciones máximas, la unidad de apoyo psicológico y la coordinación por diferentes colectivos se evaluaron con las puntuaciones más bajas. El análisis del contenido de la pregunta abierta ofrece argumentos explicativos de los resultados cuantitativos. CONCLUSIONES El estudio permitió evaluar de manera válida y fiable la implementación de un circuito de apoyo a profesionales confinados, además de reconocer áreas de mejora.

    Abstract in English:

    ABSTRACT OBJECTIVE To evaluate the implementation of a telephone system in a department of Primary Care in Barcelona, Spain, supporting health professionals confined by COVID-19. METHODS We conducted an observational, descriptive, cross-sectional study with confined professionals, between March 11 and May 31, 2020. We emailed a questionnaire with 18 closed-ended questions and one open-ended question and performed a descriptive analysis of the closed-ended answers and an analysis of the thematic content of the open-ended question. RESULTS Thirty-nine hundred and ninety-eight professionals evaluated the system overall with a score of 6.54 on a scale of 1 to 10. The evaluation of the format of calls made in the support system had higher scores, while the psychological support unit and the coordination of the different groups had lower scores. The content analysis of the open-ended question provides explanatory arguments for the quantitative results. CONCLUSIONS The study allowed a valid and reliable evaluation of the implementation of a support system for confined professionals, in addition to recognizing areas for improvement.
  • Factors associated with diagnosis of stages I and II lung cancer: a multivariate analysis Original Article

    Emmerick, Isabel Cristina Martins; Singh, Anupama; Powers, Maggie; Lou, Feiran; Lin, Poliana; Maxfield, Mark; Uy, Karl

    Abstract in English:

    ABSTRACT OBJECTIVE To present the overall survival rate for lung cancer and identify the factors associated with early diagnosis of stage I and II lung cancer. METHODS This is a retrospective cohort study including individuals diagnosed with lung cancer, from January 2009 to December 2017, according to the cancer registry at UMass Memorial Medical Center. Five-year overall survival and its associated factors were identified by Kaplan–Meier curves and Cox’s proportional hazards model. Factors associated with diagnosing clinical stage I and II lung cancer were identified by bivariate and multivariate backward stepwise logistic regression (Log-likelihood ratio (LR)) at 95% confidence interval (CI). RESULTS The study was conducted with data on 2730 individuals aged 67.9 years on average, 51.5% of whom female, 92.3% white, and 6.6% never smoked. Five-year overall survival was 21%. Individuals diagnosed with early-stage disease had a 43% five-year survival rate compared to 8% for those diagnosed at late stages. Stage at diagnosis was the main factor associated with overall survival [HR = 4.08 (95%CI: 3.62–4.59)]. Factors associated with early diagnosis included patients older than 68 years [OR = 1.23 (95%CI: 1.04–1.45)], of the female gender [OR = 1.47 (95%CI: 1.24–1.73)], white [OR = 1.63 (95%CI: 1.16–2.30)], and never-smokers [OR = 1.37 (95%CI: 1.01–1.86)]; as well as tumors affecting the upper lobe [OR = 1.46 (95%CI: 1.24–1.73)]; adenocarcinoma [OR = 1.43 (95%CI: 1.21–1.69)]; and diagnosis after 2014 [OR = 1.61 (95%CI: 1.37–1.90)]. CONCLUSIONS Stage at diagnosis was the most decisive predictor for survival. Non-white and male individuals were more likely to be diagnosed at a late stage. Thus, promoting lung cancer early diagnosis by improving access to health care is vital to enhance overall survival for individuals with lung cancer.
  • Contributions of school context to caries on anterior teeth: a multilevel analysis Original Article

    Prata, Isolda Mirelle de Lima Ferreira; Neves, Érick Tássio Barbosa; Lima, Larissa Chaves Morais de; Dutra, Laio da Costa; Ferreira, Fernanda Morais; Paiva, Saul Martins; Granville-Garcia, Ana Flávia

    Abstract in English:

    ABSTRACT OBJECTIVE To investigate whether oral health literacy (OHL) and school context are associated with untreated dental caries on the anterior teeth of adolescents. METHODS A representative cross-sectional study was conducted with 746 students aging 15 to 19 in the city of Campina Grande, Brazil. The guardians answered a questionnaire addressing sociodemographic data and the absence/presence of private health insurance. Two examiners were trained for the diagnosis of dental caries using the Nyvad criteria and the measurement of OHL using the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) (Kappa > 0.80). Contextual aspects of the schools were obtained from the 2017 National School Census. Descriptive statistics were conducted, followed by unadjusted and adjusted robust negative binomial regression for complex samples (p < 0.05). RESULTS The average number of anterior teeth with untreated caries was 0.95 (SD = 1.77). Among individual factors, the male sex (RR = 1.64; 95%CI: 1.24–2.16), inadequate level of OHL (RR = 2.03; 95%CI: 1.13–1.63), marginal level of OHL (RR = 1.87; 95%CI: 1.05–3.33) and not having private health insurance (RR = 1.34; 95%CI: 1.07–1.68) were associated with untreated caries on anterior teeth. Among school contextual factors, the number of students in the classroom (RR = 2.64; 95%CI: 1.78–3.93), number of public oral health services in the district (RR = 0.14; 95%CI: 0.05–0.39) and average income of the district in which the school is located (RR = 0.99; 95%CI: 0.98–0.99) were associated with the outcome. CONCLUSIONS Sociodemographic factors, having private health insurance, OHL, and school context exerted an influence on the occurrence of untreated dental caries on anterior teeth in adolescents aging 15 to 19.
  • Usability in the admission monitoring system of an emergency room Original Article

    Rocha, Hertaline Menezes do Nascimento; Nascimento, Ester Batista do; Santos, Laryssa Carvalho dos; Alves, Guilherme Viturino; Farre, Anny Giselly Milhome da Costa; Santana-Filho, Valter Joviniano de

    Abstract in Portuguese:

    RESUMO OBJETIVO Desenvolver e avaliar a usabilidade de um sistema de monitoramento das internações em pronto-socorro. MÉTODOS Trata-se de uma pesquisa aplicada, com desenvolvimento de um produto de software e avaliação de sua usabilidade por enfermeiros especialistas. O desenvolvimento seguiu quatro etapas: revisão sistemática, estruturação do arcabouço do sistema, construção dos formulários do sistema e avaliação das informações geradas. Na avaliação, os especialistas simularam a utilização do sistema com a inserção de dados de um prontuário fictício, e a usabilidade foi medida pelo System Usability Scale (SUS). A pontuação e os escores foram calculados de forma individual e global. O sistema foi avaliado nos padrões: pior imaginável, pobre, mediano, bom, excelente e melhor imaginável. RESULTADOS O Sistema de Informação e Monitoramento das Internações em Pronto-Socorro (SIMIPS) realiza o monitoramento do perfil epidemiológico das internações no pronto-socorro, gestão de tempo, deterioração clínica, incidência de eventos adversos e gestão de recursos humanos. A usabilidade do SIMIPS, avaliada por 17 especialistas, atingiu o Score SUS 86,5 (melhor imaginável), e algumas sugestões de modificações foram acatadas. CONCLUSÕES O SIMIPS foi avaliado como uma ferramenta de fácil utilização, com real importância na gestão das urgências frente aos problemas de superlotação e congestão, enfrentados no Brasil.

    Abstract in English:

    ABSTRACT OBJECTIVE To develop and evaluate the usability of the admission monitoring system in an emergency room. METHODS This applied research intends to develop a software product and evaluate its usability. The development followed four stages: systematic review, structuring of the system framework, construction of system forms, and evaluation of the information generated. In the evaluation, the experts simulated the use of the system by inserting data from a fictitious medical record. We measured usability using the System Usability Scale (SUS). Scores and scores were calculated individually and globally. We propose these evaluation standards: worst case scenario, poor, average, good, excellent, and best-case scenario. RESULTS The Sistema de Informação e Monitoramento das Internações em Pronto-Socorro (SIMIPS - Information and Monitoring System for Emergency Room Admissions) monitors the epidemiological profile of admissions to the emergency room, time management, clinical deterioration, incidence of adverse events, and human resource management. The usability of SIMIPS, evaluated by 17 experts, reached the SUS Score 86.5 (best case scenario), and some suggestions for modifications were accepted. CONCLUSIONS We consider SIMIPS an easy-to-use tool, with real importance in the management of emergencies in view of overcrowding and congestion problems faced in Brazil.
  • The role of health literacy as a factor associated with tooth loss Original Article

    Tenani, Carla Fabiana; Silva Junior, Manoelito Ferreira; Lino, Carolina Matteussi; Sousa, Maria da Luz Rosário de; Batista, Marília Jesus

    Abstract in Portuguese:

    RESUMO OBJETIVO O objetivo foi analisar o papel da Literacia em Saúde (LS) como fator associado às perdas dentárias entre usuários do Sistema Único de Saúde com doenças crônicas não transmissíveis. MÉTODOS O estudo transversal e analítico foi conduzido com usuários adultos e idosos selecionados em dez Unidades de Saúde da Família sorteadas, em Piracicaba – SP, Brasil. Foi aplicado um questionário com dados sociodemográficos (sexo, idade, cor da pele e escolaridade), comportamentais (escovação e uso de fio dental), determinantes em saúde (tipo e frequência de uso de serviço de saúde médico e odontológico) e clínica (dor). As condições bucais foram coletadas por exame intrabucal do biofilme dental visível e Índice Pediodontal Comunitário. As condições clínicas sistêmicas (glicemia, hemoglobina glicada e pressóricas) foram extraídas dos prontuários. A variável explanatória foi a LS (baixa, média e alta), medida pelo Health Literacy Scale (HLS-14). RESULTADOS O desfecho foi à perda dentária medida pelo Índice de dentes permanentes cariados, perdidos e obturados. Foi realizada regressão logística com uso de um modelo conceitual para a LS (p < 0,05). Para os 238 indivíduos, a média de idade foi 62,7 anos (± 10,55). A perda dentária esteve associada à LS nos modelos de regressão ajustados por tipo de serviço odontológico, frequência odontológica e uso de fio dental. No modelo final, a perda dentária teve como fatores associados a maior idade (OR = 1,12; IC95% 1,07–1,17), menor escolaridade (OR = 3,43; IC95% 1,17–10,10), ao uso irregular de fio dental (OR = 4,58; IC95% 1,75–7,31), uso irregular do serviço odontológico (OR = 2,60; IC95% 1,32–5,12), bolsa periodontal (> 4mm) (OR = 0,31; IC95% 0,01–0,08), ter biofilme dental visível (OR = 7,23; IC95% 3,19–16,41) e maior índice de glicemia (OR = 1,98; IC95% 1,00–3,92). CONCLUSÕES A perda dentária esteve associada à LS quando ajustada por comportamentos em saúde, a partir da inclusão das variáveis sociodemográficas e condições clínicas ela perdeu a significância. No modelo final, comportamentos, determinantes em saúde e condições clínicas foram indicadores de risco da perda dentária, demonstrando a multifatorialidade envolvida neste fenômeno.

    Abstract in English:

    ABSTRACT OBJECTIVE The objective was to analyze the role of health literacy (HL) as a factor associated with tooth loss among users of the Brazilian Health System with chronic non-communicable diseases. METHODS The cross-sectional analytical study was conducted with adult and elderly users chosen at ten Family Health Clinics in a draw in the town of Piracicaba, São Paulo State, Brazil. A questionnaire was applied with sociodemographic data (sex, age, skin color and education), behavioral data (brushing and flossing), determinants in health (type of dental health services and how often) and clinical data (pain). Mouth conditions were collected by intraoral examination of visible dental biofilm and community Pediodontal Index. The systemic clinical conditions (blood glucose, glycated hemoglobin and blood pressure) were extracted from the medical records. The explanatory variable was HL (low, medium and high), measured with the Health Literacy Scale (HLS-14). RESULTS The outcome was tooth loss measured by the index of decayed, missing and filled teeth. Logistic regression was performed using a conceptual model for HL (p < 0.05). For the 238 subjects, the mean age was 62.7 years (± 10.55). Tooth loss was associated with HL in regression models adjusted by type of dental service, dental frequency, and dental floss. In the final model, the factors associated with tooth loss are older age (OR = 1,12; 95%CI: 1,07–1,17), a lower education (OR = 3,43; 95%CI: 1,17–10,10), irregular use of dental floss (OR = 4,58; 95%CI: 1.75 in–7,31), irregular use of dental services (n = 2,60; 95% 1,32–5,12), periodontal pocket (> 4 mm) (n = 0,31; 95%CI: 0,01–0,08), having visible dental biofilm (OR = 7,23; 95%CI: 3,19–16,41) and a higher level of blood sugar (glucose) (n = 1,98; 95%CI: 1.00–3,92). CONCLUSIONS tooth loss was associated with HL when adjusted by health behaviors; when sociodemographic variables and clinical conditions were included, it was less significant. In the final model, behaviors, determinants in health and clinical conditions were risk indicators of tooth loss, showing the multifactorial nature of this phenomenon.
  • Sampling plan and methodological aspects: a household healthcare survey in Piauí Original Article

    Rodrigues, Lays Arnaud Rosal Lopes; Costa e Silva, Danilla Michelle; Oliveira, Edina Araújo Rodrigues; Lavôr, Layanne Cristina de Carvalho; Sousa, Rosana Rodrigues de; Carvalho, Rumão Batista Nunes de; Farias Junior, Gilvo de; Formiga, Laura Maria Feitosa; Sousa, Artemizia Francisca de; Cardoso, Maria Regina Alves; Slater, Betzabeth; Conde, Wolney Lisbôa; Paiva, Adriana de Azevedo; Frota, Karoline de Macêdo Gonçalves

    Abstract in Portuguese:

    RESUMO OBJETIVO Descrever os aspectos metodológicos do Inquérito de Saúde Domiciliar no Piauí (ISAD-PI), bem como avaliar a conformidade do plano amostral em relação à precisão e aos efeitos do desenho, dado que os inquéritos populacionais de saúde constituem instrumentos importantes para o monitoramento da situação de saúde da população. MÉTODOS O ISAD-PI foi um estudo de base populacional, transversal, que analisou as condições de vida e situação de saúde da população residente nas áreas urbanas dos municípios de Teresina e Picos, no Piauí. A amostragem foi realizada por conglomerados, em dois estágios: Unidades Primárias de Amostragem e domicílios. Para o cálculo do tamanho da amostra, considerou-se a estratificação da população de ambas as cidades, de acordo com a idade dos indivíduos, para ambos os sexos. Para avaliação da conformidade do plano amostral, foi avaliada a taxa de “não-resposta” (TNR) e, além disso, as estimativas de proporções segundo sexo e idade, bem como as prevalências de determinantes sociais de saúde, que foram analisadas em relação à precisão por meio do coeficiente de variação da proporção do erro padrão (Cv-pˆ) e do efeito do delineamento (deff). Foram considerados adequados Cv-pˆ menores que 20%, e deff menores que 1,5. A TNR-Total dos domicílios foi de 38,2% em Teresina e de 38,3% em Picos. Foram realizadas 24 estimativas de proporção em relação à idade e ao sexo e 48 estimativas de prevalência de determinantes sociais e de saúde, totalizando 72 estimativas, das quais 71 apresentaram Cv-pˆ menor que 20% e 61 apresentaram deff menor ou igual a 1,5. CONCLUSÃO Dados gerados a partir do ISAD-PI poderão contribuir para a avaliação das condições de saúde e morbidade na população. Ademais, aspectos metodológicos empregados nesta pesquisa poderão servir de base para estudos realizados em outras cidades do Brasil.

    Abstract in English:

    ABSTRACT OBJECTIVE To describe the methodological aspects of the Piauí home healthcare survey (ISAD-PI) and assess the relation between sampling plan, precision, and design effects, assuming that population health surveys are relevant instruments for health monitoring. METHODS ISAD-PI was a population-based cross-sectional study that analyzed the living conditions and health status of the population residing in urban areas in the municipalities of Teresina and Picos, in Piauí. Sampling was carried out by conglomerates in two stages: Primary Sampling Units and households. To calculate the sample size, we considered the stratification of the population in both cities, according to the age of the individuals. We evaluated the “non-response” rate (NRR) and estimated the proportions according to sex and age, as well as the prevalence of social determinants of health in order to assess the compliance of the sampling plan. Analyses related to the precision according to the coefficient of proportion variation of the standard error (Cv-pˆ) and the design effect (deff). Cv-pˆ less than 20% and deff less than 1.5 were considered adequate. The total NRR of households was 38.2% in Teresina and 38.3% in Picos. We carried out twenty-four proportion estimates in relation to age and sex and 48 prevalence of social and health determinants estimates, totaling 72 estimates. Among them, 71 had Cv-pˆ less than 20% and 61 had deff less than or equal to 1.5. CONCLUSION Data generated from the ISAD-PI may contribute to the assessment of health and morbidity conditions in the population. Furthermore, methodological aspects employed in this research may serve as a basis for studies carried out in other cities in Brazil.
  • Characteristics of Brazilian school food and physical activity environments: PeNSE 2015 Original Article

    Souza, Lucyane Barbosa Oliveira; Azevedo, Ana Beatriz Coelho de; Bandoni, Daniel Henrique; Canella, Daniela Silva

    Abstract in Portuguese:

    RESUMO OBJETIVO Caracterizar o ambiente alimentar e o ambiente para a prática de atividade física em escolas brasileiras públicas e privadas, bem como desenvolver indicadores-síntese de avaliação desses ambientes. MÉTODOS Estudo transversal, realizado com dados oriundos de questionário sobre características da escola da Pesquisa Nacional de Saúde do Escolar 2015 respondido pelo diretor ou responsável pelas escolas, referentes a 3.040 escolas públicas e privadas de todo o território nacional. As variáveis relacionadas aos ambientes alimentar e de prática de atividades físicas foram descritas isoladamente e, adicionalmente, foi desenvolvido um indicador-síntese para cada um dos ambientes, com pontuação variando de 0 a 100. A frequência de cada variável e a pontuação média dos escores foi descrita segundo a esfera administrativa (pública ou privada). RESULTADO A oferta de alimentação escolar foi predominante na rede pública (97,8%) e a presença de cantinas na rede privada (89,8%). A presença de pontos alternativos de venda foi similar nas duas esferas. A disponibilidade de todos os marcadores de alimentação saudável e não saudável nas cantinas foi mais frequente nas escolas privadas. A pontuação do escore “Disponibilidade de alimentos e bebidas” foi maior para as escolas públicas (64,9), comparada à das privadas (55,8). A caraterização do ambiente para a prática de atividade física mostrou que a presença de quadra de esporte e de material esportivo foi frequente em escolas públicas (69,2% e 90,7%, respectivamente) e em escolas privadas (94,1% e 99,8%, respectivamente), ainda que em frequência significativamente maior no segundo grupo. A pontuação do escore “Disponibilidade de estruturas e materiais” foi maior entre escolas privadas do que entre as públicas (63,3 e 41,6, respectivamente). CONCLUSÕES O ambiente alimentar de escolas públicas foi mais favorável à promoção da alimentação saudável que o de escolas privadas, sendo que o oposto foi verificado para o ambiente para a prática de atividade física.

    Abstract in English:

    ABSTRACT OBJECTIVE To characterize the food and physical activity environments in Brazilian public and private schools, and develop indicators to evaluate them. METHODS This is a cross-sectional study conducted with data from a questionnaire on school characteristics of the 2015 National Adolescent School-based Health Survey, answered by principals or coordinators, referring to 3040 public and private schools throughout the country. The variables related to food and physical activity environments were described in isolation, and an indicator was developed for each environment, with scores ranging from 0 to 100. The frequency and mean score of each variable were described according to the administrative sphere (public or private). RESULTS The public sector showed a predominance of school meals offer (97.8%), whereas the private sector, of canteens (89.8%). Both had a similar frequency of alternative food outlets in the surroundings. Private schools provided all markers of healthy and unhealthy eating in canteens more frequently. Public schools scored higher in “Food and beverage availability” (64.9) than private schools (55.8). The characteristics of physical activity environments showed that sports courts and sports or games equipment were common in public (69.2% and 90.7%, respectively) and private schools (94.1% and 99.8%, respectively), though at a significantly higher frequency in the second group. Private schools scored higher in “Structures and materials availability” than public schools (63.3 and 41.6, respectively). CONCLUSIONS Public schools provide a more favorable food environment, whereas private schools, a physical activity environment.
  • Relationship between team climate and satisfaction at work in the Family Health Strategy Original Article

    Peduzzi, Marina; Agreli, Heloise Lima Fernandes; Espinoza, Pilar; Koyama, Mitti Ayako Hara; Meireles, Everson; Baptista, Patrícia Campos Pavan; West, Michael

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar associação entre clima de equipe, características das equipes e satisfação no trabalho em equipes da Estratégia Saúde da Família com Saúde Bucal (ESF com SB). MÉTODOS Correlacional transversal com equipes da ESF com SB no município de São Paulo. Universo de 1.328 equipes e amostra aleatória de 124 equipes com 1.231 profissionais. Aplicado questionário com dados de caracterização das equipes, escala de clima de equipe e de satisfação no trabalho. Realizada análise de validade, dos escores de clima e satisfação via média dos profissionais de cada equipe, análise de agrupamentos, associação entre variáveis pela correlação de Pearson e Qui-Quadrado e testado modelo de regressão linear para os dois fatores de satisfação no trabalho. RESULTADOS Verificou-se associação diretamente proporcional entre clima de equipe e satisfação no trabalho. Quanto maior clima com relação a objetivos da equipe, maior satisfação intrínseca no trabalho e com ambiente físico, quanto maior clima com relação a objetivos da equipe e orientação para as tarefas, maior satisfação com as relações hierárquicas. Verificou-se no grupo com melhor clima de equipe, maior porcentagem de equipes classificadas com melhor satisfação no trabalho e no grupo de pior clima de equipe, maior porcentagem de equipes com a mais baixa satisfação no trabalho. CONCLUSÕES O estudo traz evidências consistentes, embora moderadas, de associação entre clima favorável ao trabalho em equipe e satisfação no trabalho na ESF com SB, com destaque para as dimensões de clima, objetivos comuns e orientação para a tarefa, constituindo subsídio para a gestão e educação permanente das equipes, visando a qualidade da atenção às necessidades de saúde de usuários, família e comunidade na APS.

    Abstract in English:

    ABSTRACT OBJECTIVE To analyze the association between team climate, team characteristics and satisfaction at work in teams of the Estratégia Saúde da Família com Saúde Bucal (Family Health Strategy with Oral Health) (ESF with SB). METHODS Cross-sectional correlational study with ESF teams with SB in the municipality of São Paulo. Universe of 1,328 teams and random sample of 124 teams with 1,231 professionals. Applied questionnaire with data teams’ characterization, team climate scale, and satisfaction at work. Analysis of validity, of climate and satisfaction scores through mean among professionals in each team, cluster analysis, association between variables by Pearson’s correlation and Chi-square, and tested linear regression model for the two factors of satisfaction at work. RESULTS There was a directly proportional association between team climate and satisfaction at work. The better the climate with regard to team goals, the greater the intrinsic satisfaction at work and with the physical environment. The better the climate with regard to team goals and task orientation, the greater the satisfaction with hierarchical relations. The group with best team climate reported higher percentage of teams ranked with better satisfaction at work, and in the group with the worst team climate there was higher percentage of teams with the lowest satisfaction at work. CONCLUSIONS The study provides consistent although moderate evidence of association between favorable teamwork climate and job satisfaction in ESF with SB. It emphasizes the dimensions of climate, common goals and task orientation, and may serve as subsidy for management and permanent education of teams, aiming at the quality of care to the health needs of users, family and community in APS.
  • Ageism against older adults in the context of the COVID-19 pandemic: an integrative review Review

    Silva, Marcela Fernandes; Silva, Diego Salvador Muniz da; Bacurau, Aldiane Gomes de Macedo; Francisco, Priscila Maria Stolses Bergamo; Assumpção, Daniela de; Neri, Anita Liberalesso; Borim, Flávia Silva Arbex

    Abstract in Portuguese:

    RESUMO OBJETIVO Descrever os principais resultados de estudos sobre preconceito, estereotipia e discriminação relacionados à idade (ageismo) no contexto da pandemia da covid-19. MÉTODOS Trata-se de uma revisão integrativa da literatura sobre o ageismo no contexto da pandemia da covid-19, realizada entre maio e junho de 2020, a partir das seguintes bases de dados: Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Web of Science (Thompson Reuters), Scopus (Elsevier Science), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Eletronic Library Online (SciELO). RESULTADOS Foram analisadas 21 publicações que discorreram sobre o ageismo durante a pandemia, suas origens, consequências e implicações ético-políticas. As publicações identificadas são de natureza teórica com abordagem crítico-reflexiva, sendo 90,5% artigos opinativos (n = 19) e 9,5% de pesquisa (n = 2). Os principais resultados encontrados apontam críticas em relação à destinação de recursos e cuidados intensivos baseados exclusivamente no critério etário. São também apontados os impactos do isolamento social, o uso das tecnologias e mídias sociais e as relações intergeracionais no cenário da covid-19. CONCLUSÃO A maioria das publicações indicam que o ageismo sempre esteve presente, mas tornou-se mais evidente durante a pandemia da covid-19 como forma de discriminação contra idosos. Ressalta-se que discursos “ageistas” podem influenciar negativamente na vida dos idosos e causar impactos sociais e psicológicos prejudiciais.

    Abstract in English:

    ABSTRACT OBJECTIVE To report the main results of studies on prejudice, stereotyping, and age-based discrimination (ageism) in the context of the COVID-19 pandemic. METHODS This is an integrative review of the literature on ageism in the context of the COVID-19 pandemic, conducted between May and June 2020, with data collected from the following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Web of Science (Thompson Reuters), Scopus (Elsevier Science), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and Scientific Eletronic Library Online (SciELO). RESULTS Twenty-one publications addressing ageism during the pandemics, its origins, consequences, and ethical and political implications were analyzed. All publications were theoretical with a critical/reflexive approach, being 90,5% opinion articles (n = 19) and 9,5% research (n = 2). The main findings indicate criticisms regarding resources allocation and intensive care based exclusively on age. The results also highlight the impacts of social isolation, the use of technologies and social media, and intergenerational relationships within the COVID-19 scenario. CONCLUSION According to most publications, although ageism has always been present, it became more evident during the COVID-19 pandemic as a form of discrimination against older adults. “Ageist” discourses may exert a negative influence in older adults’ lives, causing severe social and psychological impacts.
  • Sedentary behavior and motor competence in children and adolescents: a review Review

    Santos, Guilherme dos; Guerra, Paulo Henrique; Milani, Suedem Andrade; Santos, Ariane Brito Diniz; Cattuzzo, Maria Teresa; Ré, Alessandro Hervaldo Nicolai

    Abstract in Portuguese:

    RESUMO OBJETIVO Sintetizar as evidências de estudos que analisaram as associações entre comportamento sedentário e competência motora em crianças e adolescentes. MÉTODOS Revisão sistemática de artigos originais que analisaram possíveis associações entre comportamento sedentário e competência motora em crianças e adolescentes (3–18 anos de idade), sem restrições quanto ao delineamento de estudo, instrumentos e protocolos de análise. Os artigos foram identificados por meio de buscas nas bases PubMed, Web of Science, Academic Search Premier, Cinahl, Medline e SPORTDiscus, assim como em listas de referências. O nível de evidência foi avaliado de acordo com a quantidade de estudos que reportaram significância estatística nas associações entre as variáveis e a qualidade dos artigos (o risco de viés). RESULTADOS De 2.462 estudos iniciais, 22 compuseram a síntese (duas intervenções, nove longitudinais e onze transversais). Desses, em 13 foram observadas associações negativas entre as variáveis, mais frequentemente na faixa etária de sete a catorze anos. Na análise do risco de viés, as principais limitações dos estudos foram “amostragens por conveniência” e “não descrição do dimensionamento amostral”. CONCLUSÕES A evidência disponível sugere que o comportamento sedentário está negativamente associado à competência motora em crianças do ensino fundamental, embora a evidência seja incerta nos anos pré-escolares; a síntese de resultados dos estudos longitudinais sugere que o comportamento sedentário afeta negativamente o desenvolvimento da competência motora. É importante que futuros estudos tenham maior controle sobre os determinantes socioculturais e aprofundem os conhecimentos em relação ao sexo e à faixa etária, assim como dos métodos e indicadores utilizados para avaliação das duas variáveis.

    Abstract in English:

    ABSTRACT OBJECTIVE To synthesize evidence from studies that analyzed the associations between sedentary behavior and motor competence in children and adolescents. METHODS Systematic review of original articles that analyzed possible associations between sedentary behavior and motor competence in children and adolescents (3–18 years of age), without restrictions on study design, instruments and analysis protocols. The articles were identified through searches in the PubMed, Web of Science, Academic Search Premier, Cinahl, Medline and SPORTDiscus databases, as well as in reference lists. The level of evidence was evaluated according to the amount of studies that reported statistical significance in the associations between the variables and the quality of the articles (risk of bias). RESULTS Of 2,462 initial studies, 22 composed the synthesis (two interventions, nine longitudinal and eleven cross-sectional studies). Of these, in 13, we observed negative associations between the variables, more often in the age group of seven to fourteen years. In the analysis of risk of bias, the main limitations of the studies were “convenience sampling” and “no description of sample sizing”. CONCLUSIONS The available evidence suggests that sedentary behavior is negatively associated with motor competence in elementary school children, although the evidence is uncertain in the preschool years; the synthesis of results from longitudinal studies suggests that sedentary behavior negatively affects the development of motor competence. It is important that future studies have greater control over sociocultural determinants and deepen knowledge regarding sex and age, as well as the methods and indicators used to evaluate the two variables.
  • Hepatitis B prevalence in Brazilian waste pickers: a systematic review with meta-analysis Review

    Souza-Silva, Gabriel; Mol, Marcos Paulo Gomes

    Abstract in English:

    ABSTRACT OBJECTIVE: To describe the hepatitis B prevalence in Brazilian waste pickers. METHODS: We performed a literature search in the SciELO, Biblioteca Virtual em Saúde (BVS), PubMed and Web of Science databases using the descriptors: “hepatitis B” AND (“informal recycling” OR “waste picker” OR “recyclable waste collectors” OR “solid waste segregator”) AND (“recyclable waste” OR “solid waste”) AND Brazil. Epidemiological studies on HBV in Brazilian waste pickers published prior to February 2020 were included and evaluated for quality and bias using a funnel plot. RESULTS: This meta-analysis consisted of five articles. Prevalence of HBV surface antigen seropositivity was 14% (95%CI: 6%–22%) in Brazilian waste pickers. CONCLUSION: HBV prevalence in Brazilian waste pickers remains high. There should be more campaigns showing the importance of vaccination and personal protective equipment use.
  • Effectiveness of GeneXpert® in the diagnosis of tuberculosis in people living with HIV/AIDS Review

    Faria, Mariana Gaspar Botelho Funari de; Andrade, Rubia Laine de Paula; Camillo, Ana Julia Gonçalves; Leite, Karina Fonseca de Souza; Saita, Nanci Michele; Bollela, Valdes Roberto; Rezende, Carlos Eduardo Menezes de; Monroe, Aline Aparecida

    Abstract in Portuguese:

    RESUMO OBJETIVO Identificar e sintetizar o conhecimento científico produzido a respeito da efetividade do teste GeneXpert no diagnóstico da tuberculose (TB) pulmonar em pessoas vivendo com HIV/aids. MÉTODOS Revisão integrativa da literatura, cuja busca foi feita nas plataformas Embase, Scopus, PubMed, Cinahl, Academic Search Premier, Socindex e Lilacs, em dezembro de 2019. Os estudos levantados passaram por duas etapas de seleção: leitura dos títulos e resumos por dois revisores de forma independente, utilizando a plataforma Rayyan e leitura integral dos mesmos. Foram incluídos 19 estudos primários em inglês, português e espanhol que respondiam à pergunta norteadora do estudo: Qual é a efetividade do teste GeneXpert no diagnóstico da TB pulmonar em pessoas que vivem com HIV/aids? RESULTADOS A utilização do GeneXpert aumentou substancialmente a detecção de casos de TB entre a população coinfectada com HIV, com sensibilidade que variou de 68% a 100%, sendo superior à baciloscopia. A especificidade variou de 91,7% a 100%; o valor preditivo positivo, de 79,2% a 96,1%; e o valor preditivo negativo, de 84,6% a 99,3%, valores considerados semelhantes à baciloscopia pela maioria dos estudos. O teste também foi comparado com as diferentes formas de realização da cultura e outros testes moleculares, sendo considerado inferior apenas ao Xpert Ultra. CONCLUSÃO É possível afirmar que locais com alta incidência de HIV se beneficiariam com a implantação do teste GeneXpert, uma vez que sua efetividade no diagnóstico da TB pulmonar nessa população é expressiva quando comparada à baciloscopia, teste que foi por muito tempo amplamente utilizado para a detecção dos casos.

    Abstract in English:

    ABSTRACT OBJECTIVE To identify and synthesize the scientific knowledge produced regarding the effectiveness of the GeneXpert test in the diagnosis of pulmonary tuberculosis (TB) in people living with HIV/AIDS. METHODS Integrative literature review, which was searched on Embase, Scopus, PubMed, Cinahl, Academic Search Premier, Socindex, and LILACS platforms, in December 2019. The studies surveyed went through two stages of selection: reading of titles and abstracts by two reviewers independently; using the Rayyan platform and reading. Nineteen primary studies in English, Portuguese, and Spanish that answered the study’s guiding question were included: How effective is the GeneXpert test in the diagnosis of pulmonary TB in people living with HIV/AIDS? RESULTS The use of GeneXpert substantially increased the detection of TB cases among the population co-infected with HIV/AIDS, with sensitivity ranging from 68% to 100%, superior to sputum smear microscopy. Specificity ranged from 91.7% to 100%; the positive predictive value from 79.2% to 96.1%; and the negative predictive value from 84.6% to 99.3%. These values were considered similar to sputum smear microscopy by most studies. We also compared these results with different ways of performing culture and other molecular tests, being considered inferior only to the Xpert Ultra. CONCLUSION It is possible to affirm that places with a high incidence of HIV/AIDS would benefit from the implementation of the GeneXpert test, entailing effectiveness in diagnosing pulmonary TB in this population when compared to sputum smear microscopy, a widely used test for detection of cases.
  • Primary health care challenge for nursing professionals: a narrative review Review

    Duran-Niño, Erika Yurley; Campos de Aldana, María Stella; Arboleda de Pérez, Ligia Betty

    Abstract in Spanish:

    RESUMEN OBJETIVO Realizar una revisión narrativa de la literatura científica sobre la formación en la atención primaria en salud (APS) en los profesionales de enfermería permitiéndonos conocer los retos ante la renovación de esta estrategia. MÉTODOS Se realizó revisión de la literatura encontrada seleccionando 55 artículos de varias fuentes científicas, entre los últimos 10 años, en bases de datos electrónicas (MEDLINE, IME, LILACS, Centro Cochrane Iberoamericano, Embase, CUIDEN, CINAHL, BDIE); la selección se realizó mediante la interpretación, síntesis y análisis crítico de los artículos seleccionados. RESULTADOS Las instituciones de educación superior en Colombia vienen trabajando en la formación de los estudiantes de pregrado, respondiendo a los ejes establecidos en el fortalecimiento del recurso humano en salud. Esto, para la aplicación del modelo integral de atención en salud, enfocándolo al fortalecimiento de los perfiles laborales y adquisición de competencias que puedan generar aportes significativos a la realidad y necesidades de individuo, familia, comunidad, así como las diferentes culturas y grupos étnicos con humanización, acogiéndose al sistema general de seguridad social en salud. En diferentes países se ha realizado análisis de los enfoques de APS renovada e integral, implicando transformaciones en la educación con la formación por competencias, trabajo interprofesional, trabajo en equipo, fortaleciendo la comunicación con la comunidad y equipo de salud. CONCLUSIONES Basado en la revisión narrativa, se resalta la importancia de desarrollar estudios investigativos de cómo han sido las intervenciones realizadas por los estudiantes con las competencias adquiridas en su proceso formativo y la gestión para mejorar las condiciones de salud de la comunidad.

    Abstract in English:

    ABSTRACT OBJECTIVE Carry out a narrative review of scientific literature on nursing professionals training in primary health care (PHC), which allows us to know the challenges facing the renewal of this strategy. METHODS Review of the literature found, selection of 55 articles from various scientific sources in the last 10 years in electronic databases (MEDLINE, IME, LILACS, Centro Cochrane Iberoamericano, Embase, CUIDEN, CINAHL, BDIE). The selected articles were submitted to an interpretation, synthesis, and critical analysis process for the purpose of selection. RESULTS Higher education institutions in Colombia have been working on training of undergraduate students responding to the axes established in the strengthening of human resources in health. This training is used for the application of the integral health care model, focusing on the strengthening of work profiles and the acquisition of competencies that can generate significant contributions to the reality and needs of the individual, family, community, as well as to the different cultures and ethnic groups with humanization, under the general social security health system. An analysis of renewed and comprehensive PHC approaches has been carried out in different countries involving transformations in education with training by competencies, interprofessional work, teamwork, strengthening communication with the community, and health team. CONCLUSIONS Based on the narrative review, this research highlights the importance of developing studies on interventions carried out by students with acquired competencies in their training process and management to improve health conditions of the community.
  • Educational interventions for physical activity among Brazilian adults: systematic review Review

    Guerra, Paulo Henrique; Soares, Hugo Falqueto; Mafra, Ana Beatriz; Czarnobai, Izadora; Cruz, Guilherme Airon; Weber, William Vinícius; Farias, Juliano Cesar Huf; Loch, Mathias Roberto; Ribeiro, Evelyn Helena Corgosinho

    Abstract in Portuguese:

    RESUMO OBJETIVO Sumarizar as principais evidências de intervenções educativas delineadas para o aumento dos níveis de atividade física (AF) em adultos brasileiros. MÉTODOS Revisão sistemática de estudos de intervenção conduzidos no Brasil, que implementaram componentes educativos com a finalidade de promover o aumento dos níveis de AF em populações de adultos (18 a 65 anos). Em outubro de 2020, buscas sistemáticas foram conduzidas em seis bases de dados e nas listas de referências dos artigos avaliados. RESULTADOS Dos 2.511 artigos iniciais, nove compuseram a síntese. Foram observadas amostras com características específicas (como vulnerabilidade social, inatividade física e sobrepeso ou obesidade), com maior número de mulheres. Cinco intervenções (55,6%) ocorreram nos cenários da atenção primária à saúde (APS) do Sistema Único de Saúde (SUS). Apenas em quatro estudos (44,4%) houve descrição dos referenciais pedagógicos estruturantes das abordagens educativas, dentro os quais o aconselhamento se configurou como a estratégia mais utilizada, como aquelas realizadas por meio de encontros presenciais, visitas domiciliares, palestras e chamadas telefônicas (n = 8; 88,9%). Resultados positivos foram observados em três distintos indicadores: aumento do volume semanal de AF (n = 4); aumento do índice de AF no lazer (n = 1); e aumento da proporção de mulheres classificadas como “muito ativas/ativas” (n = 1). Visto as especificidades amostrais, o domínio “seleção dos participantes” apresentou elevado número de intervenções com alto risco de viés. CONCLUSÕES As abordagens educativas produziram alguns efeitos positivos em distintos indicadores de AF, destacando-se o aconselhamento como principal estratégia utilizada e as abordagens que envolveram outras temáticas de saúde, como nutrição e estresse. Contudo, frente aos diversos determinantes da AF no Brasil, é importante que futuras intervenções sejam conduzidas em variadas localizações do país, de forma que avaliem, de maneira mais ampla, seus processos de implementação e articulação com os distintos profissionais que atuam na APS.

    Abstract in English:

    ABSTRACT OBJECTIVE To summarize the main evidence from educational interventions designed to increase levels of physical activity (PA) among Brazilian adults. METHODS Systematic review of intervention studies carried out in Brazil that implemented educational components aimed at promoting increased levels of PA among adult populations (18 to 65 years old). In October 2020, systematic searches were conducted in six databases, and in the reference lists of the assessed studies. RESULTS Of the initial 2,511 studies, nine were included in the synthesis. Samples with specific characteristics (such as social vulnerability, physical inactivity, and overweight or obesity) were observed, with a greater number of women. Five interventions (55.6%) occurred in primary healthcare settings (PHC) of the Brazilian Unified Health System (SUS). Only four studies (44.4%) described the pedagogical frameworks structuring the educational approaches, among which counseling was the most used strategy, such as those carried out through face-to-face meetings, home visits, lectures, and phone calls (n = 8; 88.9%). Positive results were observed in three different indicators: increase in weekly PA volume (n = 4); increase in leisure-time PA rate (n = 1); and increase in the proportion of women classified as “very active/active” (n = 1). Given the sampling specificities, the domain “participant selection” showed a high number of interventions with high risk of bias. CONCLUSIONS Educational approaches engendered some positive effects on different PA indicators, notably counseling as the main strategy used and approaches involving other health themes, such as nutrition and stress. However, considering the several determinants of PA in Brazil, future interventions should be conducted in different locations of Brazil in order to evaluate, in a broader way, their implementation processes and articulation with the many professionals working in PHC.
  • Brazilian Oral Health Policy: metasynthesis of studies on the Oral Health Network Review

    Costa Junior, Sylvio da; Araujo, Pierre Guedes; Frichembruder, Karla; Hugo, Fernando Neves

    Abstract in Portuguese:

    RESUMO OBJETIVO Analisar o desempenho da rede de cuidados em saúde bucal orientada a partir sua implantação, em 2004 até 2020, segundo publicações sobre o tema. MÉTODOS Trata-se de uma pesquisa com descrição metodológica de metassíntese. RESULTADOS As buscas resultaram em 600 publicações completas (586 na primeira busca e mais 14 na segunda busca), de acordo com os critérios estabelecidos. Foram excluídos 539 artigos: 151 artigos após análise de duplicidade, 236 artigos após a leitura do título, 45 pelo tipo de publicação e 107 artigos após leitura do resumo, por não se enquadrarem na temática da pesquisa. Dessa forma, foram selecionadas e analisadas 61 publicações originais e mais 29 publicações em snowball sampling, totalizando 90 publicações. A partir dessa seleção,optou-se por usaro modelo proposto pelo Projeto de Avaliações de Desempenho de Sistemas de Saúde – PROADESS. O estudo se utilizará de seus princípios norteadores sobre a dimensão “Desempenho dos Serviços de Saúde”. CONCLUSÃO O conjunto analisado permitiu identificar que a forma como o Estado brasileiro organiza e financia o atendimento em saúde bucal possibilitou a ampliação do acesso e do número de procedimentos realizados, mas não da criação de uma efetiva Rede de cuidados integrais, após mais de uma década de implementação do Brasil Sorridente.

    Abstract in English:

    ABSTRACT OBJECTIVE Analyze the performance of the oriented oral health care network from its implementation, in 2004 to 2020, according to publications on the subject. METHODS This is a research with a methodological description of metasynthesis. RESULTS The searches resulted in 600 complete publications (586 in the first search and another 14 in the second search), according to the established criteria. 539 articles were excluded: 151 after duplication analysis, 236 after reading the title, 45 by type of publication and 107 after reading the abstract, as they did not fit the research theme. Thus, 61 original publications and another 29 publications in snowball sampling were selected and analyzed, totaling 90 publications. From this selection, we chose to use the model proposed by the Projeto de Avaliações de Desempenho de Sistemas de Saúde (PROADESS — Health Systems Performance Assessment Project). The study will use its guiding principles on the dimension “Health Services Performance”. CONCLUSION The analyzed set allowed us to identify that the way the Brazilian State organizes and finances oral health care made it possible to expand access and the number of procedures performed, but not the creation of an effective comprehensive care network, after more than a decade of implementation of Brasil Sorridente (Smiling Brazil).
  • Oropharyngeal colostrum immunotherapy and nutrition in preterm newborns: meta-analysis Review

    Xavier Ramos, Michelle de Santana; Martins, Camilla da Cruz; Souza, Elivan Silva; Vieira, Graciete Oliveira; Gomes-Filho, Isaac Suzart; Figueiredo, Ana Claudia Morais Godoy; Pereira, Maurício Gomes; Cruz, Simone Seixas da

    Abstract in English:

    ABSTRACT OBJECTIVE To investigated the effect of oropharyngeal colostrum immunotherapy in reducing the time required for very low birth weight preterm newborns (VLBW-PTNB: < 1,500g and < 37 weeks) to achieve full enteral nutrition. METHODS Literature search was conducted using four databases, including gray literature, with additional manual search of the references of selected articles. Eligibility criteria consisted of randomized clinical trials, without restriction regarding the date or language of the publication. Two independent reviewers performed the article selection and data extraction. The random-effects meta-analysis used a non-standard technique to assess the mean difference in days to achieve full enteral nutrition, carried out by the Stata 15 statistic program. RESULTS The systematic review comprised 10 studies, and five were selected for meta-analysis, with a population of 764 VLBW-PTNB and gestational age of birth between 25 and 32 weeks. The studies were conducted between 2011 and 2018 in North America, Asia and Africa, with only one conducted in South America. Altogether, they reported the number of days it took 708 VLBW-PTNB to achieve full enteral nutrition, with newborns treated with immunotherapy showing a shorter time in only three studies. Meta-analysis showed a mean difference of -4.26 days, (95% CI -7.44; -1.08d), with high heterogeneity (I2 = 83.1%). CONCLUSION The use of oropharyngeal colostrum immunotherapy can reduce the time for VLBW-PTNB to achieve full nutrition when compared to those who used a placebo or received routine care.
  • Response to college students’ mental health needs: a rapid review Review

    Gaiotto, Emiliana Maria Grando; Trapé, Carla Andrea; Campos, Celia Maria Sivalli; Fujimori, Elizabeth; Carrer, Fernanda Campos de Almeida; Nichiata, Lucia Yassuko Izumi; Cordeiro, Luciana; Bortoli, Maritsa Carla de; Yonekura, Tatiana; Toma, Tereza Setsuko; Soares, Cassia Baldini

    Abstract in Portuguese:

    RESUMO OBJETIVO Apresentar opções estratégicas para apoiar a adoção de políticas de fortalecimento da saúde mental de universitários da área da saúde, a serem implementadas por instituições universitárias. MÉTODOS Revisão rápida, sem delimitação de período, com buscas realizadas de maio a junho de 2020, em 21 fontes de dados bibliográficos, incluindo literatura cinzenta. Utilizaram-se as palavras-chave: saúde mental, estudantes e universidade. O processo de seleção priorizou revisões sistemáticas sobre intervenções em saúde mental para estudantes universitários em cursos da área da saúde, e considerou, também, outros tipos de revisão e estudos primários relevantes. RESULTADOS Foram incluídos 45 estudos: 34 revisões sistemáticas, uma síntese de evidências, um overview, uma revisão de escopo, três revisões narrativas, três relatos de experiência e dois artigos de opinião. As evidências desses estudos apoiaram a elaboração de quatro opções: 1) estabelecer e apoiar políticas de fortalecimento da saúde mental de estudantes dos cursos da área da saúde; 2) integrar programas de atenção à saúde mental, ampliar sua oferta e facilitar seu acesso pelos estudantes; 3) promover programas educacionais e estratégias de comunicação relacionadas ao sofrimento psíquico contemporâneo e ao seu enfrentamento, para que os estudantes conheçam os serviços e recursos e identifiquem práticas de fortalecimento; 4) monitorar e avaliar continuamente as necessidades em saúde mental dos estudantes dos cursos da área da saúde. CONCLUSÕES As opções são desafiadoras e exigem que as universidades estabeleçam comissões institucionais para implementar uma política de fortalecimento da saúde mental dos estudantes universitários da área da saúde, com capacidade de reconhecer as diversas necessidades em saúde, incluindo as manifestações de sofrimento psíquico; integrar ações internas da universidade entre si e aos serviços do Sistema Único de Saúde; implementar e monitorar as ações que compõem a política de saúde mental.

    Abstract in English:

    ABSTRACT OBJECTIVE To present strategic options to support the adoption of mental health strengthening policies for university students in the field of health, to be implemented by university institutions. METHODS Rapid review, without period delimitation, with searches carried out from May to June 2020, in 21 sources of bibliographic data, including gray literature. The following keywords were used: mental health, students and university. The selection process prioritized systematic reviews of mental health interventions for university students in health care courses, and also considered other types of review and relevant primary studies. RESULTS Forty-five studies were included: 34 systematic reviews, an evidence synthesis, an overview, a scope review, three narrative reviews, three experience reports and two opinion articles. The evidence from these studies supported the development of four options: 1) to establish and support policies to strengthen the mental health of students in health care courses; 2) to integrate mental health care programs, expand their offer and facilitate access by students; 3) to promote educational programs and communication strategies related to contemporary psychic suffering and its confrontation, so that students can get to know the services and resources and identify strengthening practices; 4) to continuously monitor and assess the mental health needs of students in health care courses. CONCLUSIONS The options are challenging and require universities to establish institutional commissions to implement a policy to strengthen the mental health of university students in the health area, with the ability to recognize the different health needs, including manifestations of psychic suffering ; to integrate the university’s internal actions with each other and with the services of the Unified Health System; to implement and monitor the actions that make up the mental health policy.
  • Health Technology Assessment: informed by science or in the service of politics? Comment

    De Soárez, Patrícia Coelho

    Abstract in Portuguese:

    RESUMO A juventude da Avaliação de Tecnologias em Saúde (ATS), enquanto política institucional no âmbito nacional, sinaliza a necessidade de uma reflexão sobre como se deu sua implementação, sob as perspectivas de sua inserção na política de saúde e do campo científico. Ao final de sua primeira década, levantam-se as perguntas: a ATS se traduziu em uma política de saúde (policy) informada pela ciência? Sua fundamentação científica foi usada a serviço da política (politics)? Para compreender esse processo político, aplicamos a teoria de múltiplos fluxos formulada por John Kingdon. Estabeleceu-se um equilíbrio instável entre o uso da ciência para informar a política e o uso político da ciência. A sobrevivência dessa política dependerá não só da ciência, mas da arte de orquestrar os interesses dos vários agentes, de forma que a ATS se torne uma política de saúde de fortalecimento e sustentabilidade do SUS.

    Abstract in English:

    ABSTRACT The youth of Health Technology Assessment (HTA), as an institutional policy at the national level, signals the need to reflect on how its implementation took place under the perspective of its insertion in health policy and the scientific field. At the end of its first decade, these questions arise: has HTA translated into a health policy informed by science? Has its scientific foundation been used in the service of politics? To understand this political process, we apply the multiple-streams framework formulated by John Kingdon. The use of science to inform policy and the political use of science present themselves in an unstable balance. The survival of this policy will depend not only on science but on the art of orchestrating the interests of various agents so that HTA becomes a health policy for strengthening and sustainability of SUS.
  • SARS-CoV-2 vaccines–induced thrombotic thrombocytopenia: should we consider immuno-hypersensitivity? Comment

    Reuben, Rine Christopher; Adogo, Lillian Yami

    Abstract in English:

    ABSTRACT The coronavirus disease 2019 (COVID-19) pandemic is significantly causing unprecedented clinical, socioeconomic, and public health challenges globally. The successful global administration of effective, safe and sustainable vaccine(s) is widely believed to be crucial in mitigating as well as preventing COVID-19. However, the rising cases of severe adverse events following immunization (AEFI) with COVID-19 vaccines including thrombosis, thrombocytopenia, and in some instances, death have created serious global concerns and could enormously contribute to vaccine hesitancy. Although the complete underlying pathophysiology and immunopathology of the COVID-19 vaccines related to AEFI, including thrombosis and/or anaphylaxis, are yet to be determined, exploring possible immuno-hypersensitivity could be crucial in the mechanisms associated with these reactions, thereby mitigating their occurrences as well as restoring confidence in vaccine administration for a COVID-19 free world.
  • Taxonomy for citizen actions on public health and climate change: a proposal Comment

    Álvarez-Miño, Lidice; Montoya, Robinson Taboada

    Abstract in English:

    ABSTRACT Facing complex issues such as climate change and its effects on public health require the participation of various actors. The research tool citizen science is one way for people to get involved. Through it, citizens collaborate with scientists to find solutions to problems in their territories. From a participatory work with citizens, we designed a taxonomy proposal, which can facilitate citizen and community action in suggesting research ideas. We expect stakeholders to use it to systematically classify and code initial questions and answers on public health and climate change issues. The development of this taxonomy integrates the global agenda of Sustainable Development Goals (SDG) in such a way that citizens not only help their communities but also, the direct fulfillment of SDGs such as Climate Action (SDG 13), indirectly impacting other SDGs — given their interdependent nature (SDG 3, SDG 5, SDG 6, SDG 7, SDG 11, SDG 12). The systematic classification and coding of citizens’ contributions worldwide will contribute to the large-scale organized collection of information to be analyzed in proposing better responses to reduce the impacts of climate change on health.
  • Body weight changes in the NutriNet Brasil cohort during the covid-19 pandemic Brief Communication

    Costa, Caroline dos Santos; Steele, Eurídice Martínez; Leite, Maria Alvim; Rauber, Fernanda; Levy, Renata Bertazzi; Monteiro, Carlos Augusto

    Abstract in Portuguese:

    RESUMO Este estudo descreve modificações no peso corporal de participantes da coorte NutriNet Brasil (n = 14.259) ocorridas durante a pandemia de covid-19. Foram analisados dados informados em período anterior ao início da pandemia (26/01/2020 a 18/03/2020) e cerca de 6 meses após (14/09/2020 a 19/10/2020). O ganho de peso ≥ 2 kg alcançou 19,7% dos participantes, mostrando-se diretamente associado ao sexo masculino, à menor escolaridade e à presença prévia de excesso de peso, sendo inversamente associado à idade. A perda de peso ≥ 2kg alcançou 15,2% dos participantes, mostrando-se diretamente associada ao sexo masculino e à presença prévia de excesso de peso, sendo inversamente associada à idade.

    Abstract in English:

    ABSTRACT This study describes body weight changes among participants of the NutriNet Brasil cohort (n = 14,259) during the covid-19 pandemic. We analyzed data reported before the pandemic onset (01/26/2020 to 03/18/2020) and about six months after (09/14/2020 to 10/19/2020). Our results show that 19.7% of the participants gained ≥ 2 kg. Weight gain was directly associated with male gender, lower education, and previous presence of overweight, and inversely associated with age. In turn, 15.2% lost ≥ 2kg, being directly associated with male gender and previous presence of overweight and inversely associated with age.
  • Neurodevelopment in the third year of life in children with antenatal ZIKV-exposure Brief Communication

    Aizawa, Carolina Yuri Panvequio; Caron, Deyse Mayara Rodrigues; Souza, Carolina Barbosa de; Kozima, Paula Fernanda Augusto; Damasceno, Luana; Einspieler, Christa; Marschik, Peter B.; Brasil, Patrícia; Schmitt, Ana Carolina Basso; Nielsen-Saines, Karin; Hasue, Renata Hydee

    Abstract in English:

    ABSTRACT We report cognitive, language and motor neurodevelopment, assessed by the Bayley-III test, in 31 non-microcephalic children at age 3 with PCR-confirmed maternal Zika virus exposure (Rio de Janeiro, 2015–2016). Most children had average neurodevelopmental scores, however, 8 children (26%) presented delay in some domain. Language was the most affected: 7 children (22.6%) had a delay in this domain (2 presenting severe delay). Moderate delay was detected in the cognitive (3.2%) and motor (10%) domains. Maternal illness in the third trimester of pregnancy and later gestational age at birth were associated with higher Bayley-III scores. Zika-exposed children require long-term follow-up until school age.
  • Impact of nonpharmaceutical strategies on trends of COVID-19 in São Paulo State Brief Communication

    Fortaleza, Cristiane Ravagnani; Vilches, Thomas Nogueira; Almeida, Gabriel Berg de; Ferreira, Claudia Pio; Souza, Lenice do Rosário de; Fortaleza, Carlos Magno Castelo Branco

    Abstract in English:

    ABSTRACT Interrupted time series analyses were conducted to measure the impact of social distancing policies (instituted on March 22, 2020) and of subsequent mandatory masking in the community (instituted on May 4, 2020) on the incidence and effective reproductive number of COVID-19 in São Paulo State, Brazil. Overall, the impact of social distancing both on incidence and Rt was greater than the incremental effect of mandatory masking. Those findings may reflect either a small impact of face masking or the loosening of social distancing after mandatory use of masks.
  • Baseline factors associated with death in a COVID-19 hospital cohort, Sao Paulo, 2020 Brief Communication

    Konstantyner, Thais Claudia Roma de Oliveira; Martins, Camila Bertini; Luppi, Carla Gianna; Yashiro, Suely Miyuki; Sanches, Nívia Aparecida Pissaia; Cohrs, Frederico Molina; Ferreira, Paulo Abrão; Medeiros, Eduardo Alexandrino

    Abstract in English:

    ABSTRACT This study aimed to verify socio-demographic and baseline clinical factors associated with death in a hospital cohort of patients with COVID-19. A retrospective cohort study was conducted between February and December 2020 in a university hospital in the city of São Paulo, using Hospital Epidemiology Center data. RT-PCR-positive patients were selected to compose the sample (n = 1,034). At the end of the study, 362 (32%) patients died. In this cohort, age equal to or greater than sixty years (HR = 1.49) and liver disease (HR = 1.81) were independent risk factors for death from COVID-19 associated with higher in-hospital mortality.
  • Abortion after the Zika virus epidemic in Northeast Brazil Letter To The Editor

    Diniz, Debora; Medeiros, Marcelo; Madeiro, Alberto
  • Erratum: Aging with health: aging in place strategies of a Portuguese population aged 65 years or older Erratum

  • Errata Errata

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