Abstract in Portuguese:

RESUMO Lutzomyia longipalpis (Lutz & Neiva, 1912) é o vetor do agente da leishmaniose visceral (LV) no Novo Mundo de maior relevância epidemiológica. Em 25 de outubro de 2023, o Centro de Informações Estratégicas em Vigilância em Saúde de Macapá detectou um caso de LV no bairro Km9 desse município. O objetivo deste estudo foi identificar as espécies de flebotomíneos nessa área a fim de auxiliar na confirmação da autoctonia do caso. Foram coletados 12 espécimes, desses, cinco foram de Lu. longipalpis, confirmando assim a presença do vetor do agente da LV e a possível autoctonia da transmissão.

Abstract in English:

ABSTRACT Lutzomyia longipalpis (Lutz & Neiva, 1912) constitutes the most epidemiologically relevant vector of visceral leishmaniasis (VL) in the New World. On October 25, 2023, the Macapá Center for Strategic Information in Health Surveillance registered a case of VL in the Km9 neighborhood, in Macapá. This study aimed to describe the Phlebotominae species in this area to assist the confirmation of the autochthony of the case. In total, 12 specimens were collected, of which five belonged to the Lutzomyia longipalpis species, confirming the presence of the VL agent vector and the possible autochthony of the transmission.

Abstract in English:

ABSTRACT OBJECTIVE To describe two low-burden diet quality scores and evaluate their performance in reflecting the dietary share of the least and most processed foods defined within the Nova food system classification. METHODS This cross-sectional study included data from the NutriNet-Brasil cohort. Participants answered the Nova24hScreener, a 3-minute self-administered questionnaire measuring the consumption of a set of foods on the day before. Food items included in this tool belong to two main groups of the Nova classification: unprocessed or minimally processed whole plant foods (WPF, 33 items) and ultra-processed foods (UPF, 23 items). Two scores were obtained by summing the number of items checked: the Nova-WPF and the Nova-UPF. We compared the scores, respectively, with the dietary intake (% of total energy) of all unprocessed or minimally processed whole plant foods and all ultra-processed foods obtained from a full self-administered web-based 24-hour recall performed on the same day. RESULTS The approximate quintiles of each score had a direct and linear relationship with the corresponding % of energy intake (p-value for linear trend < 0.001). We found a substantial agreement between the intervals of each score and the corresponding % of energy intake (Nova-WPF score: Prevalence-Adjusted and Bias-Adjusted Kappa (PABAK) 0.72, 95%CI 0.64–0.81; Nova-UPF score: PABAK 0.79, 95%CI 0.69–0.88). CONCLUSIONS These two scores performed well against the dietary share of unprocessed or minimally processed whole plant foods and ultra-processed foods in Brazil and can be used to evaluate and monitor diet quality.

Abstract in Portuguese:

RESUMO OBJETIVO Analisar os investimentos realizados em medicamentos pelos entes federados e as assimetrias desses investimentos de 2016 a 2020 que podem representar impactos na oferta e no acesso desses medicamentos no SUS. MÉTODOS Trata-se de um estudo exploratório, retrospectivo, para identificar quem são os principais entes responsáveis pelo investimento em medicamentos da Atenção Básica dos municípios, a evolução, as contrapartidas e as diferenças regionais deste investimento entre 2016 e 2020. RESULTADOS Os valores gastos com medicamentos pelos municípios brasileiros foram maiores que a contrapartida para o CBAF do MS ou do MS + Estado em todos os anos analisados. As médias percentuais de repasses de recursos federais e de gastos municipais variam conforme região do Brasil. A média do valor per capita investido em medicamentos pelos municípios aumentou entre 2016 e 2020 (aplicada a deflação), sendo maior o impacto para os municípios de menores IDHM. O programa Farmácia Popular atinge principalmente os municípios dos maiores portes populacionais e de maiores IDHM, não sendo suficiente, portanto, para enfrentar as iniquidades de acesso apontadas. CONCLUSÕES Houve ampliação das desigualdades na capacidade dos municípios para assegurar o acesso aos medicamentos, principalmente entre os municípios mais vulneráveis, acumulando ainda mais riscos de agravos e mortes por doenças sensíveis à atenção primária.

Abstract in English:

ABSTRACT OBJECTIVE To analyze the investments made in medicines by the federated entities and the asymmetries in these investments from 2016 to 2020, which may have an impact on the supply of and access to these medicines in the SUS. METHODS This is an exploratory, retrospective study to identify who are the main entities responsible for investment in Primary Care medicines in municipalities, the evolution, counterparts, and regional differences of this investment between 2016 and 2020. RESULTS The amounts spent on medicines by Brazilian municipalities were higher than the contribution to the CBAF from the MS or the MS + State in all the years analyzed. The average percentages of federal funds transferred and municipal spending varied according to the region of Brazil. The average per capita amount invested in medicines by municipalities increased between 2016 and 2020 (deflation applied), with a greater impact for municipalities with lower MHDI. The Farmácia Popular program mainly reaches municipalities with the largest populations and the highest MHDI and is therefore not enough to address the inequalities in access pointed out. CONCLUSIONS There has been a widening of inequalities in the capacity of municipalities to ensure access to medicines, especially among the most vulnerable municipalities, accumulating even more risks of illnesses and deaths from primary care-sensitive diseases.

Abstract in Portuguese:

RESUMO O objetivo deste comentário é descrever as características, o desenvolvimento e as funcionalidades da plataforma de coleta de dados de consumo alimentar QuestNova. A plataforma foi desenvolvida por dois especialistas em tecnologia da informação, com suporte de uma equipe do Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde da Universidade de São Paulo (Nupens/USP). O processo de desenvolvimento ocorreu em etapas, com todas as funcionalidades de cada passo sendo minuciosamente testadas por múltiplos membros da equipe antes de avançar para o próximo. A QuestNova é uma plataforma online gratuita, que disponibiliza três instrumentos autoaplicáveis para avaliação do consumo alimentar, com base na classificação Nova: Screener-Nova, QFA-Nova e R24h-Nova. Na plataforma, o pesquisador pode selecionar o instrumento de interesse e enviá-lo por meio de um link aos participantes de sua pesquisa, que o responderão de forma autônoma, dispensando a presença de um entrevistador. Bancos de dados contendo indicadores relevantes para a avaliação da alimentação segundo o nível de processamento são gerados automaticamente a partir das respostas. Um aspecto crucial da QuestNova é o seu compromisso com a confidencialidade e a segurança dos dados dos participantes. Nenhuma informação é armazenada internamente na plataforma; pelo contrário, os dados são transmitidos diretamente para uma conta no Google Drive fornecida pelo próprio pesquisador. A QuestNova democratiza o acesso a instrumentos de pesquisa inovadores, potencializando estudos sobre o impacto do processamento de alimentos na saúde brasileira. Atualizações futuras podem ampliar sua utilidade.

Abstract in English:

ABSTRACT The objective of this commentary is to describe the characteristics, development and functionalities of the food intake data collection platform QuestNova. The platform was developed by two information technology specialists, with the support of a team from Nupens/USP. The development process took place in stages, with all the functionalities of each step being thoroughly tested by multiple team members before moving on to the next. QuestNova is a free online platform that offers three self-administered instruments for assessing food intake, based on the Nova classification: Screener-Nova, QFA-Nova and R24h-Nova. On the platform, the researcher can select the instrument of interest and send it via a link to the participants in their study, who will answer it autonomously, without the presence of an interviewer. Databases containing relevant indicators for evaluating food according to the level of processing are automatically generated from the responses. A crucial aspect of QuestNova is its commitment to the confidentiality and safety of participant data. No information is stored internally on the platform; on the contrary, data is transmitted directly to a Google Drive account provided by the researcher themselves. QuestNova democratizes access to innovative research tools, boosting studies on the impact of food processing on Brazilian health. Future updates may extend its usefulness.

Abstract in English:

ABSTRACT OBJECTIVE To investigate the relationship between childhood consumption of ultra-processed foods and symptoms of hyperactivity/inattention in adolescents from São Leopoldo, a city in southern Brazil. METHODS Data were collected at four distinct stages: when participants were 12-16 months old in 2001 and 2002 and later when they were 3–4, 7–8, and 12–13 years old. During the interview at 12–16 months, mothers were asked about the introduction of sugar in their child’s diet. Two 24-hour recall surveys were conducted with children aged 3–4, 7–8, and 12–13 years to assess their consumption of ultra-processed foods. At the age of 12–13 years, the participants completed the Hyperactivity/Inattention subscale of the Strengths and Difficulties Questionnaire (SDQ), which screens for mental health problems. RESULTS Among the 173 adolescents, 22.5% exhibited hyperactivity symptoms. The consumption of ultra-processed foods in grams, kilocalories, and as a percentage of energy intake at 3-4 years old were found to be predictors of hyperactivity/inattention symptoms (RR: 0.81, 95%CI: 0.69–0.95; RR: 1.01, 95%CI: 1.00–1.02; RR: 1.02, 95%CI:1.01–1.02; RR: 1.25, 95%CI:1.04–1.51, respectively). CONCLUSION The consumption of ultra-processed foods at an early age was associated with hyperactivity and inattention symptoms in adolescence.

Abstract in Portuguese:

RESUMO OBJETIVO Propor um método de detecção e análise do sub-registro e evidenciar o seu potencial efeito financeiro em face da implementação do Programa Previne Brasil. MÉTODOS Foi realizado um estudo ecológico de análise dos exames citopatológicos na área programática 3.1 do município do Rio de Janeiro. Os dados foram coletados do barramento do Datasus, incluindo as informações relativas aos relatórios dos laboratórios terceirizados dos exames citopatológicos e aquelas disponíveis no Sistema de Informação em Saúde para a Atenção Básica (Sisab) e Sistema de Informação do Câncer do Colo do Útero (Siscolo) do Datasus/Ministério da Saúde. RESULTADOS Os sub-registros estimados por unidade de saúde totalizaram 108.511 exames nos últimos dois anos na área programática 3.1, o que corresponde a um total estimado de R$ 435.129,00 que teriam sido deixados de receber, caso o Programa Previne Brasil já estivesse efetivado no período estudado. CONCLUSÃO A principal contribuição do artigo está na apresentação de evidência empírica dos potenciais efeitos do sub-registro para o financiamento da atenção primária à saúde. Além disso, há dois outros achados significativos – primeiro, evidencia fragilidades no processo de registro das informações de saúde inerentes a regiões vulneráveis; segundo, indica um círculo vicioso potencialmente alimentado pela alteração brusca dos condicionantes do financiamento da atenção primária à saúde, além de potenciais consequências para os demais níveis de atenção.

Abstract in English:

ABSTRACT OBJECTIVE To propose a method for detecting and analyzing under-registration and highlight its potential financial effect in view of the implementation of the Previne Brasil Program. METHODS An ecological study was carried out to analyze cytopathological exams in programmatic area 3.1 in the municipality of Rio de Janeiro. The data was collected from the Departamento de Informática do Sistema Único de Saúde (DATASUS - Department of Informatics of the Unified Health System) database, including information on reports from outsourced cytopathology laboratories and those available in the Sistema de Informação em Saúde para a Atenção Básica (SISAB - Health Information System for Primary Care) and the Sistema de Informação do Câncer do Colo do Útero (SISCOLO - Cervical Cancer Information System) of DATASUS/Ministry of Health. RESULTS The estimated under-registrations per health unit totaled 108,511 exams in the last two years in the programmatic area 3.1 area, which corresponds to an estimated total of R$ 435,129.00 that would have been foregone if the Previne Brasil Program had been in place during the period studied. CONCLUSION The article’s main contribution lies in the presentation of empirical evidence of the potential effects of under-registration on Primary Health Care financing. In addition, there are two other significant findings - firstly, it highlights weaknesses in the process of recording health information inherent to vulnerable regions; secondly, it indicates a vicious circle potentially fueled by sudden changes in Primary Health Care funding conditions, in addition to potential consequences for other levels of care.

Abstract in English:

ABSTRACT OBJECTIVE To investigate perspectives of people with disabilities in Brazil regarding the access to primary healthcare. METHODS In-depth interviews were conducted with 44 individuals with disabilities in Pernambuco, Distrito Federal, and São Paulo between March 2020 and November 2021. These interviews were transcribed, coded, and analysed thematically, using the Levesque framework to identify healthcare access barriers. RESULTS Participants expressed a solid understanding of their healthcare needs and existing obstacles. However, individuals with hearing and visual impairments experience challenges because of communication barriers. In Pernambuco, the Community Health Agent was often the initial point of contact for primary care services. Public transportation lacked accessibility, from buses to driver attitudes, posing difficulties for people with disabilities. More accessible transportation and improved urban infrastructure could enhance service access. High medication costs were reported due to limited healthcare unit availability. Communication accessibility issues, inadequate audio-visual resources and equipment were also identified as barriers. Attitudinal barriers among healthcare professionals and subpar home visit services further hinder access. CONCLUSION To address these challenges and improve the well-being of individuals with disabilities in Brazil, comprehensive action is essential. This includes leadership, governance, and resource allocation reforms to meet healthcare needs. Initiatives like disability-focused training for service providers, enhanced transportation options, improved information accessibility, and increased support from community healthcare workers can collectively enhance the lives of people with disabilities.

Abstract in Portuguese:

RESUMO OBJETIVO Confirmar o diagrama dos caminhos de impacto do programa e funções centrais da Estratégia Amamenta e Alimenta Brasil (EAAB) e determinar indicadores para avaliação da EAAB. MÉTODOS Trata-se de um estudo qualitativo, inserido no campo da pesquisa de implementação. A coleta de dados incluiu dois grupos focais com implementadores da EAAB, análise documental e revisão da literatura. A análise incluiu revisão das sugestões dos participantes e duas etapas de revisão do diagrama e dos nomes dos caminhos de impacto e funções centrais. Em seguida, foram construídas questões para a avaliação da EAAB com base no diagrama confirmado. Os indicadores do framework RE-AIM (reach, effectiveness, adoption, implementation, maintenance) foram adaptados para o contexto da EAAB. As questões de avaliação foram revisadas segundo domínios RE-AIM e, por fim, foram determinados indicadores para cada questão de avaliação. RESULTADOS Este estudo avançou na análise de implementação da EAAB, definindo 22 indicadores para seu monitoramento e avaliação. A maioria dos indicadores já são utilizados na implementação, entretanto, a análise com o framework RE-AIM permitiu atualizar os indicadores para serem mais específicos, mensuráveis e relevantes para os objetivos desejados. CONCLUSÃO Os resultados do estudo apoiam a aplicação pragmática da avaliação RE-AIM em programas de saúde e incentivam o planejamento de indicadores de avaliação de outros programas de saúde e desenvolvimento infantil na atenção primária.

Abstract in English:

ABSTRACT OBJECTIVE To confirm the diagram of the program’s impact pathways and Estratégia Amamenta e Alimenta Brasil (EAAB - Brazilian Breastfeeding and Complementary Feeding Strategy) core functions, and to determine indicators for evaluating EAAB. METHODS This is a qualitative study within the field of implementation research. Data collection included two focus groups with EAAB implementers, document analysis, and literature review. The analysis included a review of the participants’ suggestions and two stages of reviewing the diagram and the names of the impact pathways and core functions. Questions for evaluating the EAAB were then constructed based on the confirmed diagram. The indicators of the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance) were adapted to the EAAB context. The evaluation questions were revised according to the RE-AIM domains and, finally, indicators were determined for each evaluation question. RESULTS This study advanced the analysis of EAAB implementation, defining 22 indicators for its monitoring and evaluation. Most of the indicators are already used in implementation, however, the analysis with the RE-AIM framework allowed the indicators to be updated to be more specific, measurable, and relevant to the desired objectives. CONCLUSION The results of the study support the pragmatic application of RE-AIM evaluation in health programs and encourage the planning of evaluation indicators for other child health and development programs in primary care.

Abstract in Portuguese:

RESUMO OBJETIVO Analisar o impacto da política de austeridade fiscal (PAF) nas despesas em saúde dos municípios brasileiros, levando em consideração o porte populacional e a fonte dos recursos. MÉTODOS Utilizou-se o método de séries temporais interrompidas para analisar o efeito da PAF sobre as despesas totais, recursos transferidos pela União e recursos próprios/estaduais per capita destinados à saúde nos municípios. A série temporal analisada compreendeu o período de 2010 a 2019, com periodicidade semestral. Adotou-se o primeiro semestre de 2015 como data de início da intervenção. Os municípios foram agregados em pequenos (até 100 mil habitantes), médios (101 mil a 400 mil habitantes) e grandes (mais de 400 mil habitantes). Os dados foram obtidos no Sistema de Informações sobre Orçamentos Públicos em Saúde. RESULTADOS Os resultados para a média nacional dos municípios demonstram que a PAF teve um impacto negativo sobre o nível de despesas totais e de recursos próprios/estaduais destinados à saúde no primeiro semestre de 2015, não provocando mudanças estaticamente significativas nas tendências de nenhum dos indicadores analisados no período posterior a 2015. Municípios pequenos tiveram queda nas despesas totais, enquanto os grandes, nos recursos próprios/estaduais e os médios, em ambas as variáveis. Não houve queda estatisticamente significante no volume de recursos transferidos pela União no momento imediato à implementação da PAF em nenhum dos grupos municipais analisados. No médio prazo, a PAF gerou impacto negativo apenas nos grandes municípios, que tiveram reduções significativas nas tendências de recursos próprios/estaduais e transferidos pela União destinados à saúde. CONCLUSÃO No geral, o impacto da PAF no financiamento da saúde dos municípios se deu de forma imediata e a partir da queda de recursos próprios/estaduais destinados à saúde. Nos municípios grandes, entretanto, o impacto foi perdurável entre 2015 e 2019, afetando, principalmente, as despesas com saúde oriundas de recursos da União.

Abstract in English:

ABSTRACT OBJECTIVE To analyze the impact of the fiscal austerity policy (PAF) on health spending in Brazilian municipalities, considering population size and source of funds. METHODS The interrupted time series method was used to analyze the effect of the PAF on total expenditure, resources transferred by the Federal Government, and own/state per capita resources allocated to health in the municipalities. The time series analyzed covered the period from 2010 to 2019, every six months. The first semester of 2015 was adopted as the start date of the intervention. The municipalities were grouped into small (up to 100,000 inhabitants), medium (101,000 to 400,000 inhabitants), and large (over 400,000 inhabitants). The data was obtained from the Sistema de Informações sobre Orçamentos Públicos em Saúde (Information System on Public Health Budget). RESULTS The results for the national average of municipalities show that the PAF had a negative impact on the level of total expenditure and own/state resources allocated to health in the first half of 2015, without causing statically significant changes in the trends of any of the indicators analyzed in the period after 2015. Small municipalities saw a drop in total expenditure, while large municipalities saw a drop in own/state resources, and medium-sized municipalities saw a drop in both variables. There was no statistically significant drop in the volume of funds transferred by the Federal Government in the immediate aftermath of the implementation of the PAF in any of the municipal groups analyzed. In the medium-term, the PAF only had a negative impact on the large municipalities, which saw significant reductions in the trends of own/state resources and those transferred by the Union for health. CONCLUSION In general, the impact of the PAF on health financing in municipalities was immediate and based on the decrease in own/state resources allocated to health. In large municipalities, however, the impact lasted from 2015 to 2019, mainly affecting health expenditure from federal funds.

Abstract in English:

ABSTRACT OBJECTIVE: To describe disability-related performance and inequality nationwide in Brazil, and the changes that took place between 2012 and 2019 after the introduction of Programme for Improving Primary Care Access and Quality (PMAQ). METHODS: We derived scores for disability-related care and accessibility of primary healthcare facilities from PMAQ indicators collected in round 1 (2011–2013), and round 3 (2015–2019). We assessed how scores changed after the introduction of PMAQ. We used census data on per capita income of local areas to examine the disability-specific care and accessibility scores by income group. We undertook ordinary least squares regressions to examine the association between PMAQ scores and per capita income of each local area across implementation rounds. RESULTS: Disability-related care scores were low in round 1 (18.8, 95%CI 18.3–19.3, out of a possible 100) and improved slightly by round 3 (22.5, 95%CI 22.0–23.1). Accessibility of primary healthcare facilities was also poor in round 1 (30.3, 95%CI 29.8–30.8) but doubled by round 3 (60.8, 95%CI 60.3–61.3). There were large socioeconomic inequalities in round 1, with both scores approximately twice as high in the richest compared to the poorest group. Inequalities weakened somewhat for accessibility scores by round 3. These trends were confirmed through regression analyses, controlling for other area characteristics. Disability-related and accessibility scores also varied strongly between states in both rounds. CONCLUSIONS: People with disabilities are being left behind by the Brazilian healthcare system, particularly in poor areas, which will challenge the achievement of universal health coverage.

Abstract in English:

ABSTRACT OBJECTIVE: To develop and validate a predictive model utilizing machine-learning techniques for estimating the length of hospital stay among patients who underwent coronary artery bypass grafting. METHODS: Three machine learning models (random forest, extreme gradient boosting and neural networks) and three traditional regression models (Poisson regression, linear regression, negative binomial regression) were trained in a dataset of 9,584 patients who underwent coronary artery bypass grafting between January 2017 and December 2021. The data were collected from hospital discharges from 133 centers in Brazil. Algorithms were ranked by calculating the root mean squared logarithmic error (RMSLE). The top performing algorithm was validated in a never-before-seen database of 2,627 patients. We also developed a model with the top ten variables to improve usability. RESULTS: The random forest technique produced the model with the lowest error. The RMLSE was 0.412 (95%CI 0.405–0.419) on the training dataset and 0.454 (95%CI 0.441–0.468) on the validation dataset. Non-elective surgery, admission to a public hospital, heart failure, and age had the greatest impact on length of hospital stay. CONCLUSIONS: The predictive model can be used to generate length of hospital stay indices that could be used as markers of efficiency and identify patients with the potential for prolonged hospitalization, helping the institution in managing beds, scheduling surgeries, and allocating resources.

Abstract in English:

ABSTRACT OBJECTIVE: To analyze the time trend of sweetened beverages consumption among Brazilian adults in 26 capitals and the Federal District, from 2007 to 2021, with focus on the most recent period (2015 to 2021). METHODS: Data from the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel - Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Survey)were used to conduct a time-series analysis (n = 731,683). The prevalence of regular consumption (five or more days/week), average daily consumption (milliliters) and nonconsumption of sweetened beverages were analyzed. Prais-Winsten regression models were used to calculate temporal trends of the indicators for the complete set of the evaluated population and by sociodemographic characteristics (sex, age group, schooling and development level of the geographic region of residence). RESULTS: Between 2007 and 2021, a reduction in the prevalence of regular consumption (-1.23 pp/year) and daily average consumption (-8.62 milliliters/year) of sweetened beverages was observed. However, between 2015 and 2021, this downward trend did not continue. The prevalence of adults who reported not consuming sweetened beverages increased (1.14 pp/year, for 2007–21), although this trend was not significant in the most recent period. CONCLUSIONS: The consumption of sweetened beverages among Brazilian adults decreased in the 15 years studied. However, this reduction was not observed more recently, suggesting that further actions must be adopted in the country so that the trend observed in the total period is maintained.

Abstract in Portuguese:

RESUMO OBJETIVO Analisar a incompletude e a tendência da incompletude da variável raça/cor nas internações por covid-19 cujo desfecho foi óbito, no Brasil, no período entre abril de 2020 e abril de 2022. MÉTODOS Estudo ecológico de série temporal sobre a incompletude da variável raça/cor nas internações por covid-19 cujo desfecho foi óbito no Brasil, suas macrorregiões e Unidades Federativas (UF), pela regressão por joinpoint, cálculo da Monthly Percent Change (MPC) e Average Monthly Percent Change (AMPC), a partir de dados do Sistema de Informação Hospitalar do Sistema Único de Saúde (SIH/SUS). RESULTADOS A incompletude da variável raça/cor nas internações por covid-19 cujo desfecho foi óbito no Brasil foi 25,85%, considerada ruim. Todas as regiões do país tiveram grau de incompletude ruim, exceto a Região Sul, considerada regular. No período analisado, a análise jointpoint revelou tendência de estabilidade na incompletude da variável raça/cor no Brasil (AMPC = 0,54; IC95% -0,64 a 1,74; p = 0,37) e nas regiões Sudeste (AMPC = -0,61; IC95% -3,36 a 2,22; p = 0,67) e Norte (AMPC = 3,74; IC95% -0,14 a 7,78; p = 0,06). As regiões Sul (AMPC = 5,49; IC95% 2,94 a 8,11; p = 0,00002) e Nordeste (AMPC = 2,50; IC95% 0,77 a 4,25;p = 0,005) apresentaram crescimento na tendência da incompletude, enquanto a Região Centro-Oeste (AMPC = -2,91; IC95% -5,26 a -0,51; p = 0,02) teve tendência de redução. CONCLUSÃO A proporção de preenchimento ruim e a tendência de estabilidade da incompletude revelam que não houve melhoria na qualidade de preenchimento da variável raça/cor durante o período da pandemia da covid-19 no Brasil, fato que pode ter ampliado as iniquidades em saúde para população negra e dificultado o planejamento de ações estratégias para essa população, considerando o contexto pandêmico. Os resultados encontrados reforçam a necessidade de fomentar a discussão sobre o tema, tendo em vista que a incompletude dos sistemas de informação em saúde amplia desigualdades no acesso aos serviços de saúde e compromete a qualidade dos dados em saúde.

Abstract in English:

ABSTRACT OBJECTIVE To analyze the incompleteness and trend of incompleteness of the race/color variable in hospitalizations due to COVID-19 whose outcome was death, in Brazil, between April 2020 and April 2022. METHODS Ecological time series study on the incompleteness of the race/color variable in hospitalizations due to COVID-19 whose outcome was death in Brazil, its macro-regions and Federative Units (FU), by joinpoint regression, calculation of Monthly Percent Change (MPC) and Average Monthly Percent Change (AMPC), based on data from the Hospital Information System of the Unified Health System (SIH/SUS). RESULTS The incompleteness of the race/color variable in COVID-19 hospitalizations with a death outcome in Brazil was 25.85%, considered poor. All regions of the country had a poor degree of incompleteness, except for the South, which was considered regular. In the period analyzed, the joinpoint analysis revealed a stable trend in the incompleteness of the race/color variable in Brazil (AMPC = 0.54; 95%CI: -0.64 to 1.74; p = 0.37) and in the Southeast (AMPC = -0.61; 95%CI: -3.36 to 2.22; p = 0.67) and North (AMPC = 3.74; 95%CI: -0.14 to 7.78; p = 0.06) regions. The South (AMPC = 5.49; 95%CI: 2.94 to 8.11; p = 0.00002) and Northeast (AMP = 2.50; 95%CI: 0.77 to 4.25; p = 0.005) regions showed an increase in the incompleteness trend, while the Midwest (AMPC = -2.91 ; 95%CI: -5.26 to -0.51; p = 0.02) showed a downward trend. CONCLUSION The proportion of poor completeness and the stable trend of incompleteness show that there was no improvement in the quality of filling in the race/color variable during the COVID-19 pandemic in Brazil, a fact that may have increased health inequalities for the black population and made it difficult to plan strategic actions for this population, considering the pandemic context. The results found reinforce the need to encourage discussion on the subject, given that the incompleteness of health information systems increases inequalities in access to health services and compromises the quality of health data.

Abstract in English:

ABSTRACT OBJECTIVE To evaluate the association between the inflammatory potential of the diet measured by the energy-adjusted diet inflammatory index (E-DII) and inflammatory markers in adolescents. METHODS This cross-sectional study was conducted among 518 adolescents aged 18 and 19 years from São Luís, Maranhão, Brazil in 2016. A semiquantitative food frequency questionnaire (FFQ) was used to assess dietary intake from which E-DII scores were calculated to determine the inflammatory potential of the diet. The associations between E-DII and inflammatory markers (hs-CRP, IL-6, IL-4, TNF-α, and IFNγ) were analyzed using multivariable linear regression. The variables included in the adjusted model were identified using the directed acyclic graph. RESULTS The diet of these adolescents was mostly pro-inflammatory; mean E-DII score was 1.71 and ranged from -2.44 to 5.58. Higher E-DII scores were positively associated with higher levels of IFNγ in the adjusted analysis (Adjusted Coef.: 1.19; 95%CI: 0.36–12.04). We observed no associations between E-DII and other inflammatory markers (hs-CRP, IL-6, IL-4, TNF-α). Study results indicate that E-DII is useful in evaluating the inflammatory potential of the diet of Brazilian adolescents. CONCLUSIONS Cross-sectionally E-DII scores were positively associated with IFNγ concentrations. Future research should examine the association between changes in E-DII scores and levels of inflammatory markers longitudinally.

Abstract in Portuguese:

RESUMO OBJETIVO Avaliar a tendência das taxas de mortalidade e os anos potenciais de vida perdidos (APVP) por suicídio entre adolescentes do Nordeste brasileiro. MÉTODOS Estudo ecológico de séries temporais, com dados secundários de 2011 a 2020 do Sistema de Informações sobre Mortalidade, de adolescentes entre 10 e 19 anos no Nordeste do Brasil. Foram incluídos os grupos de causas da 10ª Revisão da Classificação Internacional de Doenças: X60-X84 (lesões autoprovocadas intencionalmente), Y10-Y19 (intoxicação de intenção indeterminada) e Y87 (sequela de lesões autoprovocadas intencionalmente). Calculou-se os coeficientes de mortalidade e a distribuição de frequências por variáveis sociodemográficas, local de ocorrência e método de suicídio adotado. Os APVP foram estimados por sexo e idade. Foi utilizada a análise de regressão por Joinpoint e determinada a variação percentual anual (APC) com intervalos de confiança de 95%. RESULTADOS Registrou-se 2.410 óbitos, com predomínio de adolescentes entre 15 e 19 anos, sexo masculino, raça/cor parda, baixa escolaridade e, como principal local de ocorrência, o domicílio. A tendência da taxa de óbitos foi crescente no Nordeste (APC: 3,6%; p = 0,001),em meninas de 10 a 14 anos (APC: 8,7%; p = 0,003), em meninos de 15 a 19 anos (APC: 4,6%;p = 0,002) e na Bahia (APC: 8,1%; p = 0,012). Enforcamento/estrangulamento foi o principal método adotado em ambos os sexos. Os APVP por suicídio foram de 11.110 anos em 2011 e de 14.960 em 2020. CONCLUSÕES Chama a atenção a precocidade do suicídio cometido pelas meninas e o aumento da mortalidade entre os adolescentes mais velhos, sendo necessária a adoção de medidas preventivas específicas para esses grupos, a fim de reduzir esta causa evitável de morte.

Abstract in English:

ABSTRACT OBJECTIVE To assess the trend in mortality rates and years of potential life lost (YPLL) due to suicide among adolescents in Northeast Brazil. METHODS This is an ecological time series study, with secondary data from 2011 to 2020 from the Mortality Information System for adolescents aged 10 to 19 years in the Northeast region of Brazil. Groups of causes from the 10th Revision of the International Classification of Diseases were included: X60-X84 (intentionally self-inflicted injuries), Y10-Y19 (poisoning of undetermined intent), and Y87 (sequelae of intentional self-harm). Mortality coefficients and frequency distribution by sociodemographic variables, place of occurrence, and method of suicide were estimates. YPLL were estimated by gender and age. Joinpoint regression analysis was used, and the annual percentage change (APC) was determined with 95% confidence intervals. RESULTS A total of 2,410 deaths were recorded, with a predominance of adolescents aged between 15 and 19, males, of mixed-race, low schooling, and home was the main place of occurrence. The trend in the death rate was increasing in the Northeast (APC: 3.6%; p = 0.001), in girls aged 10 to 14 (APC: 8.7%; p = 0.003), in boys aged 15 to 19 (APC: 4.6%; p = 0.002) and in Bahia (APC: 8.1%; p = 0.012). Hanging/strangulation was the main method adopted by both sexes. The YPLL due to suicide were 11,110 in 2011 and 14,960 in 2020. CONCLUSION The precociousness of suicide committed by girls and the increase in mortality among older adolescents are noteworthy, and specific preventive measures need to be adopted for these groups in order to reduce this preventable cause of death.

Abstract in Portuguese:

RESUMO OBJETIVO Investigar os custos e o perfil dos pacientes que demandaram judicialmente o onasemnogene abeparvoveque (Zolgensma®) para o tratamento da atrofia muscular espinhal (AME) no Ministério da Saúde. MÉTODOS Estudo transversal, de natureza descritiva e desenho censitário, com base em registros de ações judiciais movidas contra o Ministério da Saúde no período de janeiro de 2019 a setembro de 2022. Os dados foram solicitados ao Ministério da Saúde, via Lei de Acesso à Informação. Foram extraídas informações sobre o perfil epidemiológico dos beneficiários das ações judiciais, bem como os gastos dispendidos pelo Ministério da Saúde nos casos de deferimento das solicitações. RESULTADOS Foram identificados 136 processos judiciais, dos quais 113 (83%) foram favoráveis aos pacientes ao custo de R$ 944,8 milhões no período analisado. Características demográficas (sexo e idade), clínicas (subtipos da AME, uso de suporte ventilatório ou nutricional) e do processo judicial (tipo de serviço advocatício) não foram associadas com o deferimento das ações judiciais. O uso prévio de medicamento (nusinersena ou ridisplam) foi associado com o indeferimento dos processos judiciais. Das 113 ações judiciais concedidas em favor dos pacientes, apenas seis (5,3%) atenderiam aos critérios estabelecidos atualmente pela Comissão Nacional de Incorporação de Tecnologias – Conitec (crianças com até seis meses sem suporte ventilatório e nutricional). Houve dispêndio de R$ 146 milhões com o fornecimento do Zolgensma para crianças com idade superior a dois anos, que está fora da recomendação contida na bula do medicamento. CONCLUSÕES O Ministério da Saúde incorre em um alto custo com a judicialização do Zolgensma para AME, representando 2,45% do gasto total com medicamentos no Sistema Único de Saúde, incluindo gastos das três esferas administrativas. Parte das demandas judiciais tem sido deferida em divergência com os critérios estabelecidos por agências de avaliação de tecnologias em saúde e recomendações do fabricante do medicamento.

Abstract in English:

ABSTRACT OBJECTIVE To investigate the costs and profile of patients who have filed a lawsuit against the Ministry of Health for the treatment of spinal muscular atrophy (SMA) with the onasemnogene abeparvovec (Zolgensma®). METHODS This is a cross-sectional, descriptive study with a census design, based on records of lawsuits filed against the Ministry of Health between January 2019 and September 2022. Data was requested from the Ministry of Health via the Access to Information Act. Information was extracted on the epidemiological profile of the beneficiaries of the lawsuits, as well as the expenses spent by the Ministry of Health in cases where the requests were granted. RESULTS 136 lawsuits were identified, of which 113 (83%) were favorable to patients at a cost of R$ 944.8 million in the period analyzed. Demographic (gender and age), clinical (SMA subtypes, use of ventilatory or nutritional support), and lawsuit (type of legal service) characteristics were not associated with the granting of lawsuits. Prior use of medication (nusinersena or ridisplam) was associated with the dismissal of lawsuits. Of the 113 lawsuits granted in favor of patients, only six (5.3%) would meet the criteria currently established by the National Committee for Health Technology Incorporation - Conitec (children up to six months without ventilatory and nutritional support). R$ 146 million was spent on supplying Zolgensma to children over the age of two, which is outside the recommendation contained in the drug’s package leaflet. CONCLUSIONS The Ministry of Health incurs a high cost with the judicialization of Zolgensma for SMA, representing 2.45% of total spending on medicines in the Unified Health System, including spending by the three administrative spheres. Some of the lawsuits have been granted in disagreement with the criteria established by health technology assessment agencies and the drug manufacturer’s recommendations.

Abstract in English:

ABSTRACT OBJECTIVE To identify risk factors for death from influenza A(H1N1), including the effectiveness of the vaccine against influenza A(H1N1) concerning mortality. METHODS A case-control of incident cases of influenza A(H1N1) reported in the epidemiological information systems of the states of São Paulo, Paraná, Pará, Amazonas, and Rio Grande do Sul was conducted. RESULTS 305 participants were included, 70 of them cases and 235 controls, distributed as follows: Amazonas, 9 cases/10 controls; Pará, 22 cases/77 controls, São Paulo, 19 cases/49 controls; Paraná, 10 cases/54 controls; Rio Grande do Sul, 10 cases/45 controls. These participants had a mean age of 30 years, with 33 years among cases and 25 years among controls. There was a predominance of females both among the cases and controls. Biological (age), pre-existing diseases (congestive heart failure, respiratory disease, and diabetes mellitus), and care factors (ICU admission) associated with death from influenza A(H1N1) were identified. CONCLUSION The risk factors identified in this investigation not only allowed subsidizing the elaboration of clinical conducts but also indicate important aspects for facing “new” influenza epidemics that are likely to occur in our country.

Abstract in Spanish:

RESUMEN OBJETIVO Analizar el consumo de nutrientes críticos y otros edulcorantes, según el grado de procesamiento de los alimentos en la población Antioqueña. MÉTODOS En este estudio transversal, se evaluó el consumo alimentario de 4,382 participantes del Perfil Alimentario y Nutricional de Antioquia 2019. Los alimentos procesados (AP) y productos ultraprocesados (PUP) informados por recordatorio de 24 horas se clasificaron según sistema Nova. Se usó el Modelo de Perfil de Nutrientes (MPN) de la Organización Panamericana de la Salud (OPS). Se midió la cantidad de AP y PUP consumidos con exceso en nutrientes críticos, relacionados con las enfermedades crónicas (EC). Se evaluó la diferencia en el consumo promedio, la prevalencia del consumo excesivo, y las posibilidades de inadecuación entre los grupos que tenían una dieta con y sin contenido excesivo. RESULTADOS Cerca del 50% de los AP y PUP consumidos presentaba exceso en al menos un nutriente crítico. La población consumió diariamente uno o más productos con exceso en azúcar libre (73.3%), grasa total (75.2%), grasa saturada (77.0%), sodio (83.9%) y/o edulcorantes (36.8%). Quienes consumían productos con cantidades excesivas tenían una mayor ingesta de grasas totales (> 5.8%); grasas saturadas (> 3.8%); y sodio (> 698.7 mg) en adultos y adolescentes, en niños de 5–10 años (> 659.2 mg), y en menores de 5 años (> 498 mg). Quienes consumieron productos con cantidades excesivas presentaron las mayores posibilidades de inadecuación en la dieta. CONCLUSIÓN La población antioqueña que consume AP y PUP con cantidades excesivas de azúcares libres, grasas totales, grasas saturadas, sodio y/o edulcorantes, presenta una dieta desbalanceada. Reducir el consumo de estos productos y volver a una dieta natural y/o mínimamente procesada puede ser una estrategia efectiva para alcanzar las recomendaciones de ingesta de nutrientes priorizados por OPS en la población antioqueña.

Abstract in English:

ABSTRACT OBJECTIVE To analyze the consumption of critical nutrients and other sweeteners, according to the degree of food processing in the population of Antioquia. METHODS Cross-Sectional Study. The dietary intake of 4,382 participants of the Perfil Alimentario y Nutricional de Antioquia 2019 (Antioquia Food and Nutrition Profile 2019) was evaluated. Processed foods (PF) and ultra-processed products (UPP) reported by 24-hour recall were classified according to the Nova system. The Nutrient Profile Model (NPM) of the Pan American Health Organization (PAHO) was used. The amount of PF and UPP consumed with excess of critical nutrients related to chronic diseases (CD) was measured. The difference in average intake, the prevalence of excess intake, and the likelihood of inadequacy between groups with and without excess dietary content were assessed. RESULTS Nearly 50% of the PF and UPP consumed had excess in at least one critical nutrient. The population consumed daily one or more products with excess in free sugar (73.3%), total fat (75.2%), saturated fat (77.0%), sodium (83.9%), and/or sweeteners (36.8%). Those who consumed products with excessive amounts had a higher intake of total fat (> 5.8%); saturated fat (> 3.8%); and sodium (> 698.7 mg) in adults and adolescents, in children 5–10 years (> 659.2 mg), and in children under 5 years (> 498 mg). Those who consumed products with excessive amounts presented the greatest possibilities of dietary inadequacy. CONCLUSION The population of Antioquia that consumes PF and UPP with excessive amounts of free sugars, total fat, saturated fat, sodium, and/or sweeteners presents an unbalanced diet. Reducing the consumption of these products and returning to a natural and/or minimally processed diet may be an effective strategy to achieve the nutrient intake recommendations prioritized by PAHO in the population of Antioquia.

Abstract in Portuguese:

RESUMO OBJETIVO Estimar as prevalências de acesso geral e público a medicamentos prescritos na população brasileira com 15 anos ou mais de idade em 2019 e identificar iniquidades de acesso, conforme intersecções de gênero, cor/raça, nível socioeconômico e território. MÉTODOS Foram analisados dados da Pesquisa Nacional de Saúde de 2019 com respondentes de 15 anos ou mais que tiveram prescrição de algum medicamento em atendimento de saúde realizado nas duas semanas anteriores à entrevista (n = 19.819). A variável de desfecho foi o acesso a medicamentos, subdividido em acesso geral (público, privado e misto), acesso público (via Sistema Único de Saúde – SUS) dos atendidos no SUS e acesso público (via SUS) dos não atendidos no SUS. As variáveis independentes do estudo foram utilizadas para representar eixos de marginalização: gênero, cor/raça, nível socioeconômico e território. Foram calculadas as prevalências de acesso geral e acesso público nos diferentes grupos analisados e a associação dos desfechos com os eixos mencionados foi estimada com odds ratios (OR) por meio de modelos de regressão logística. RESULTADOS Foi observada alta prevalência de acesso geral (84,9%), quando consideradas todas as fontes de obtenção, favorecendo segmentos populacionais de maior privilégio, como homens, brancos e de alto nível socioeconômico. Quando considerada apenas a obtenção no SUS dos medicamentos prescritos no próprio sistema, verificou-se uma baixa prevalência (30,4% de acesso), invertendo o acesso em benefício dos segmentos populacionais multiplamente marginalizados, como mulheres negras de baixo nível socioeconômico. CONCLUSÕES O acesso a medicamentos por meio do SUS demonstra ser um instrumento de combate às iniquidades interseccionais, evidenciando que o SUS é uma política pública eficiente na promoção da justiça social.

Abstract in English:

ABSTRACT OBJECTIVE To estimate the prevalence of general and public access to prescription drugs in the Brazilian population aged 15 or older in 2019, and to identify inequities in access, according to intersections of gender, color/race, socioeconomic level, and territory. METHODS We analyzed data from the 2019 National Health Survey with respondents aged 15 years or older who had been prescribed a medication in a healthcare service in the two weeks prior to the interview (n = 19,819). The outcome variable was access to medicines, subdivided into general access (public, private and mixed), public access (via the Unified Health System - SUS) for those treated by the SUS, and public access (via the SUS) for those not treated by the SUS. The study’s independent variables were used to represent axes of marginalization: gender, color/race, socioeconomic level, and territory. The prevalence of general and public access in the different groups analyzed was calculated and the association of the outcomes with the aforementioned axes was estimated with odds ratios (OR) using logistic regression models. RESULTS There was a high prevalence of general access (84.9%), when all sources of access were considered, favoring more privileged segments of the population, such as men, white, and those of high socioeconomic status. When only the medicines prescribed in the SUS were considered, there was a low prevalence (30.4% access) that otherwise benefited marginalized population segments, such as women, black, and people from low socioeconomic backgrounds. CONCLUSIONS Access to medicines through the SUS proves to be an instrument for combating intersectional inequities, lending credence to the idea that the SUS is an efficient public policy for promoting social justice.

Abstract in Portuguese:

RESUMO OBJETIVOS Explorar a estrutura interna e analisar evidências de invariância de mensuração do formulário de marcadores do consumo alimentar do Sistema de Vigilância Alimentar e Nutricional (Sisvan) para crianças de seis a 23 meses. MÉTODOS Utilizaram-se microdados do Sisvan de 2015 a 2019. Após análise de adequação da amostra, realizou-se análise fatorial (AF) exploratória considerando valores de cargas fatoriais (≥ 0,30 e < 0,85), comunalidade (> 0,20) e índices de ajuste do modelo – índice de Tucker-Lewis (TLI) > 0,90 e raiz do erro quadrático médio de aproximação (RMSEA) < 0,08. Empreendeu-se uma análise crítica aos itens do formulário para adequação dos parâmetros. A estabilidade de mensuração foi investigada entre grupos etários, macrorregiões e longitudinalmente por AF confirmatória multigrupo em modelos de invariância configural, métrica e escalar. A invariância configural foi aceita se RMSEA < 0,08 e TLI e índice de ajuste comparativo (CFI) > 0,90. Invariâncias métrica e escalar foram aceitas se ΔRMSEA < 0,015 e ΔCFI < 0,01, comparando-se ao modelo anterior. RESULTADOS Após análise crítica, itens do formulário foram agrupados (legumes e verduras; carnes ou ovos e fígado) e excluídos (comida de sal; mingau com leite; arroz, batata, inhame, mandioca, farinha ou macarrão). O modelo exploratório compreendeu três fatores: alimentação complementar saudável (frutas; hortaliças; vegetal ou fruta alaranjados ou folhas verdes escuras; carnes, vísceras ou ovo; feijão), ultraprocessada (iogurte; hambúrguer e/ou embutidos; bebidas adoçadas; macarrão instantâneo, salgadinhos de pacote ou biscoitos salgados; biscoito recheado, doces ou guloseimas), e láctea (leite do peito; outro leite), com cargas fatoriais, comunalidades e ajuste satisfatórios (TLI: 0,918, RMSEA: 0,071). O instrumento reformulado foi estável nos modelos de invariância testados. CONCLUSÕES Com a incorporação das modificações ao formulário do Sisvan, os marcadores subsidiam uma interpretação mais adequada da situação alimentar de crianças de seis a 23 meses.

Abstract in English:

ABSTRACT OBJECTIVE To explore the internal structure and analyze evidence of measurement invariance of the Sisvan form of food intake markers of the Food and Nutrition Surveillance System (Sisvan) for children aged six to 23 months. METHODS Sisvan microdata from 2015 to 2019 were used. After analyzing sample adequacy, exploratory factor analysis was carried out considering factor loadings (≥ 0.30 and < 0.85), communality (> 0.20), model fit indices – Tucker-Lewis index (TLI) > 0.90, and root mean square error of approximation (RMSEA) < 0.08. A critical analysis of the form items was performed to adjust the parameters. Measurement stability was investigated between age groups, macro-regions and longitudinally by multi-group confirmatory factor analysis in configural, metric, and scalar invariance models. Configural invariance was accepted if RMSEA < 0.08 and TLI and comparative fit index (CFI) > 0.90. Metric and scalar invariances were accepted if ΔRMSEA < 0.015 and ΔCFI < 0.01, compared to the previous model. RESULTS After critical analysis, items were grouped (vegetables and leafy greens; meat or eggs and liver) and excluded (salty food; porridge with milk; rice, potatoes, yams, cassava, flour, or pasta). The exploratory model comprised three factors: healthy complementary feeding (fruit; vegetables; orange or dark green leafy vegetables or fruits; meat, offal, or egg; beans), ultra-processed (yogurt; hamburger and/or sausages; sweetened drinks; instant noodles, packet snacks, or salty cookies; sandwich cookies, sweets, or treats), and milk feeding (breast milk; other milk), with satisfactory factor loadings, communalities and fit (TLI: 0.918, RMSEA: 0.071). The reformulated instrument was stable in the invariance models tested. CONCLUSIONS With the incorporation of the modifications to the Sisvan form, the food intake markers subsidize a more adequate interpretation of the feeding situation of children aged six to 23 months.

Abstract in Portuguese:

RESUMO OBJETIVO Compreender potencialidades e limites do cuidado em obesidade infantil na perspectiva da integralidade, no contexto da Atenção Primária à Saúde, em municípios brasileiros. MÉTODOS Adotou-se a abordagem qualitativa, com aplicação, em 11 municípios das cinco regiões brasileiras, de um formulário eletrônico de caráter dissertativo, derivado dos quatro eixos da integralidade definidos por Ayres (necessidades, finalidades, articulações e interações). RESULTADOS Dentre as potências para o cuidado integral, observou-se: a oferta de serviços em diferentes níveis de atenção; a relevância de programas intersetoriais no desenvolvimento de ações voltadas à multidimensionalidade da obesidade infantil; a implementação de estratégias de sistematização do cuidado e ferramentas que estimulem a ampliação do diálogo e a humanização; e a articulação intersetorial para criação de respostas adequadas às necessidades ampliadas das crianças e suas famílias. Enquanto limitações, estão: a centralização das ações nos profissionais nutricionistas e no âmbito assistencial; a não priorização da obesidade infantil nas agendas da saúde; e a insuficiência dos profissionais capacitados para lidar com a complexidade da obesidade. CONCLUSÕES Os achados sugerem que as práticas no cuidado da obesidade infantil, para que sejam transformadoras, precisam ser entendidas no âmbito da integralidade. E isso inclui (re)pensar políticas públicas, práticas profissionais, organização dos processos de trabalho para serem, de fato, mais inclusivas, participativas, dialógicas, humanizadas, solidárias, justas e, portanto, eficazes.

Abstract in English:

ABSTRACT OBJECTIVE To understand the potential and limits of care for childhood obesity from the perspective of comprehensiveness, in the context of Primary Health Care, in Brazilian municipalities. METHODS A qualitative approach was adopted, with an electronic form of a dissertative nature being applied in 11 municipalities in the five Brazilian regions, derived from the four axes of comprehensiveness defined by Ayres (needs, purposes, articulations, and interactions). RESULTS Among the strengths for comprehensive care, the following were observed: the provision of services at different levels of care; the relevance of intersectoral programs in the development of actions aimed at the multidimensionality of childhood obesity; the implementation of strategies for systematizing care and tools that encourage the expansion of dialogue and humanization; and intersectoral coordination to create appropriate responses to the expanded needs of children and their families. Limitations include: the centralization of actions in nutrition professionals and in the care sphere; the failure to prioritize childhood obesity in health agendas; and the lack of trained professionals to deal with the complexity of obesity. CONCLUSIONS The findings suggest that child obesity care practices, in order to be transformative, need to be understood in the context of comprehensiveness. And this includes (re)thinking public policies, professional practices, and the organization of work processes so that they are, in fact, more inclusive, participatory, dialogical, humanized, supportive, fair, and, therefore, effective.

Abstract in English:

ABSTRACT OBJECTIVE To identify empirical patterns of multimorbidity and quantify their associations with socioeconomic, behavioral characteristics, and health outcomes in the megacity of São Paulo. METHODS This was a cross-sectional study conducted through household interviews with residents aged 20 years or older in urban areas (n = 3,184). Latent class analysis was used to identify patterns among the co-existence of 22 health conditions. Age-adjusted prevalence ratios were estimated using Poisson regression. RESULTS The analysis of latent classes showed 4 patterns of multimorbidity, whereas 58.6% of individuals were classified in the low disease probability group, followed by participants presenting cardiovascular conditions (15.9%), respiratory conditions (12.8%), and rheumatic, musculoskeletal, and emotional conditions (12.8%). Older individuals, with lower schooling and lower household income, presented higher multimorbidity prevalence in cardiovascular, respiratory, rheumatic, musculoskeletal, and emotional conditions patterns compared with the low disease probability pattern. CONCLUSION The results showed four distinct patterns of multimorbidity in the megacity population, and these patterns are clinically recognizable and theoretically plausible. The identification of trends between patterns would make it feasible to estimate the magnitude of the challenge for the organization of health care policies.

Abstract in English:

ABSTRACT OBJECTIVE The transgender population in Brazil faces marginalization and difficulties in accessing education and health, leading many individuals to self-medicate. This study aimed to evaluate the impact of the implementation of Specialized Centers in the Transsexualizing Process (SCTP) on the use of cross-sex hormone therapy (CSHT) without medical prescription, as well as the level of education and mental health profile of these individuals. METHODS This is a cross-sectional study with data from physical and electronic medical records between September 2017 and February 2023 regarding the use of CSHT before and after the implementation of two SCTP in the state of Bahia, Brazil, in addition to data on education level, previous diagnosis of anxiety and depression of patients. RESULTS A total of 219 participants, 127 transgender men (TM) and 92 transgender women and travestis (TrTW), were assessed. A significant reduction in the prevalence of self-medication was observed in both TrTW (92.98% before and 51.43% after, p<0.001), and TM (47.17% before and 25.67% after, p = 0.010) with the implementation of SCTP. Transgender individuals who used CSHT before accessing the service were found to have a lower prevalence of depression. Self-medication was not significantly associated with education or anxiety in our sample. CONCLUSION The results indicate the need for the expansion of SCTP, as they were associated with lower rates of self-medication in the transgender population.

Abstract in Portuguese:

RESUMO Este estudo tem o objetivo de analisar a validade da autorreferência de medidas antropométricas (peso e altura) para a classificação do estado nutricional de adultos e idosos brasileiros a partir dos dados da Pesquisa Nacional de Saúde (PNS), edição de 2019. A amostra da PNS é constituída por domicílios particulares permanentes de todas as unidades federativas do Brasil e este é um recorte transversal no qual foram identificados 6.571 registros com dados aferidos e referidos, não sendo identificados dados perdidos para uma variável quando na presença de outra. A validação foi realizada com 6.381 dados após a retirada de dados atípicos. As variáveis utilizadas para estratificação foram: sexo, idade, raça/cor, escolaridade e renda e, para analisar a concordância entre as categorias do estado nutricional, foram utilizados o Coeficiente Kappa ponderado e o Coeficiente de Correlação Intraclasse (CCI). A acurácia foi analisada com base nos valores de sensibilidade, especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN). E para a validade de constructo, foi realizada uma regressão de Poisson para cada desfecho (aferido e autorreferido), com as variáveis independentes “sexo”, “cor/raça”, “escolaridade” e “renda familiar”. Todas as análises mostraram resultados positivos para a validação. Houve uma maior reprodutibilidade entre adultos (18 a 59 anos) quando comparados às pessoas idosas e entre homens quando comparados às mulheres. Esta validação indica uma possibilidade concreta de realizar estudos observacionais de associação tendo como variável de desfecho o estado nutricional referido, como uma estratégia eficiente, podendo minimizar as dificuldades operacionais frequentemente encontradas.

Abstract in English:

ABSTRACT The aim of this study was to analyze the validity of self-reported anthropometric measurements (weight and height) for classifying the nutritional status of Brazilian adults and elderly people using data from the 2019 National Health Survey (PNS). The PNS sample is made up of permanent private households from all of Brazil’s federative units and this is a cross-sectional study in which 6,571 records were identified with measured and reported data, with no missing data for one variable being identified when in the presence of another. Validation was carried out with 6,381 data after removing atypical data. The variables used for stratification were: gender, age, race/color, schooling, and income, and the weighted Kappa Coefficient and the Intraclass Correlation Coefficient (ICC) were used to analyze agreement between the nutritional status categories. Accuracy was analyzed based on sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). For construct validity, a Poisson regression was performed for each outcome (measured and self-reported), with the independent variables “gender”, “color/race”, “schooling”, and “family income”. All the analyses showed positive results for validation. There was greater reproducibility among adults (18 to 59 years old) compared to the elderly and among men compared to women. This validation indicates a concrete possibility of carrying out an association of observational studies using reported nutritional status as the outcome variable, as an efficient strategy which could minimize the operational difficulties often encountered.

Abstract in English:

ABSTRACT OBJECTIVE The COVID-19 pandemic has raised numerous concerns regarding its effects on individuals’ health and lifestyle. We aim to analyze potential changes in adolescent sleep patterns from before and during the pandemic and identify specific predictors of changes. METHODS A subgroup of adolescents from a population-based birth cohort from Pelotas, Brazil, was assessed pre-pandemic (T1, November-2019 to March-2020) and peri-pandemic (T2, August-2021 to December-2021) in in-person interviews (n = 1,949). Sleep parameters, including sleep duration and latency time on workdays and free days, as well as social jetlag (SJL), were assessed using the Munich ChronoType Questionnaire (MCTQ). Socio-demographic, pre-pandemic, and pandemic-related predictors were analyzed. Changes in sleep parameters from T1 to T2 were estimated by multivariate latent change score modeling. RESULTS The latent change factor shows a significant mean increase in workday sleep duration (M = 0.334, p < 0.001), workday sleep latency (M = 0.029, p = 0.002), and free day sleep latency (M = 0.021, p = 0.034), and a decreased in SJL (M = −0.758, p < 0.001) during the pandemic. Female adolescents presented higher increases in workday sleep duration. Adolescents who adopted a stricter social distancing level during the pandemic presented greater increases in workday sleep duration and smaller reductions in SJL. Self-evaluated insomnia during the pandemic predicted lower increases in workday and free day sleep duration and higher increases in workday and free day sleep latency. CONCLUSION The COVID-19 outbreak brought certain advantages regarding increased sleep duration and reduced SJL. However, the observed increase in sleep latency and the influence of self-reported insomnia could be related to psychological distress inherent to the pandemic.

Abstract in English:

ABSTRACT OBJECTIVE To assess maternal mortality (MM) in Brazilian Black, Pardo, and White women. METHODS We evaluated the maternal mortality rate (MMR) using data from the Brazilian Ministry of Health public databases from 2017 to 2022. We compared MMR among Black, Pardo, and White women according to the region of the country, age, and cause. For statistical analysis, the Q2 test prevalence ratio (PR) and confidence interval (CI) were calculated. RESULTS From 2017 to 2022, the general MMR was 68.0/100,000 live births (LB). The MMR was almost twice as high among Black women compared to White (125.81 vs 64.15, PR = 1.96, 95%CI:1.84–2.08) and Pardo women (125.8 vs 64.0, PR = 1.96, 95%CI: 1.85–2.09). MMR was higher among Black women in all geographical regions, and the Southeast region reached the highest difference among Black and White women (115.5 versus 60.8, PR = 2.48, 95%CI: 2.03–3.03). During the covid-19 pandemic, MMR increased in all groups of women (Black 144.1, Pardo 74.8 and White 80.5/100.000 LB), and the differences between Black and White (PR = 1.79, 95%CI: 1.64–1.95) and Black and Pardo (PR = 1.92, 95%CI: 1.77–2.09) remained. MMR was significantly higher among Black women than among White or Pardo women in all age ranges and for all causes. CONCLUSION Black women presented higher MMR in all years, in all geographic regions, age groups, and causes. In Brazil, Black skin color is a key MM determinant. Reducing MM requires reducing racial disparities.

Abstract in Portuguese:

RESUMO O enfrentamento da recente pandemia da covid-19 mostrou que o Sistema Único de Saúde (SUS) precisa aprimorar sua resiliência para lidar com o rápido alastramento de enfermidades transmissíveis sem deixar de garantir o cuidado necessário a uma população envelhecida, com comorbidades e em situação vulnerável. Este artigo identifica, analisa e discute aspectos críticos da resiliência do SUS, colocando em xeque o foco prevalente sobre a robustez e o volume dos recursos mobilizados emergencialmente na deflagração de grandes desastres. Recentes estudos demonstram que as habilidades que favorecem a adaptação a situações inesperadas emergem a partir do funcionamento cotidiano das organizações. Restringir a discussão ao simples dimensionamento das estruturas para reagir aos eventos adversos tem o efeito de engessar o seu potencial, inibindo o afloramento de habilidades transformadoras, adaptativas, de antecipação e de aprendizado necessárias para o desenvolvimento sustentável da resiliência.

Abstract in English:

ABSTRACT Coping with the recent COVID-19 pandemic has shown that the Brazilian Unified Health System (SUS) needs to improve its resilience to handle the rapid spread of communicable diseases while ensuring the necessary care for an aging population with comorbidities and in a vulnerable situation. This article identifies, analyzes, and discusses critical aspects of the resilience of the SUS, calling into question the prevailing focus on the robustness and volume of resources mobilized during the outbreak of major disasters. Recent studies demonstrate that the skills that favor adaptation to unexpected situations emerge from the daily functioning of organizations. Restricting the discussion to the mobilization of structures to respond to adverse events has the effect of limiting their potential, inhibiting the emergence of the transformative, adaptive, anticipatory, and learning skills necessary for the sustainable development of resilience.

Abstract in Portuguese:

RESUMO OBJETIVO: Contextualizar a adesão ao Prontuário Eletrônico do Cidadão (PEC) pelos municípios brasileiros e a evolução da estratégia eletrônica do Sistema Único de Saúde (e-SUS) da Atenção Primária (APS) durante seus 10 anos. MÉTODOS: Trata-se de um estudo de cunho descritivo, que agregou informações de adesão ao uso do prontuário, extraídas da base de dados da Secretaria de Atenção Primária à Saúde (SAPS) do Governo Federal, entre os anos de 2017 e 2022. Foram analisados o quantitativo de unidades básicas de saúde informatizadas que utilizavam algum prontuário eletrônico e o número das que utilizavam a Coleta de Dados Simplificada (CDS) e das que implementaram o Prontuário Eletrônico do Cidadão (PEC), no mesmo período. Também foi realizada uma síntese descritiva das funcionalidades e módulos que foram implementados no sistema durante seus 10 anos de desenvolvimento. RESULTADOS: A adesão dos municípios brasileiros ao PEC cresceu exponencialmente nos últimos cinco anos, passando de 8.930 unidades de saúde em 2017 para 26.091 em 2022. Como era de se esperar, as principais funcionalidades e melhorias desenvolvidas nessa década buscaram implementar novos fluxos e módulos de processos administrativos, de atendimento clínico e de gestão do cuidado e administração do serviço de saúde, mas também foram importantes para o sucesso do sistema aprimorar aspectos de usabilidade e de infraestrutura tecnológica da arquitetura da aplicação. CONCLUSÕES: Em 2023, celebra-se o marco de uma década do início da implantação do prontuário pelos municípios brasileiros, marcado por desafios de ordem tecnológica e de infraestrutura, bem como de melhorias e novas funcionalidades que evidenciaram a evolução tecnológica do sistema e da estratégia e-SUS APS. Mesmo que muitas outras existam, pode-se dizer que o PEC é hoje a principal ferramenta de prontuário eletrônico no Brasil, pois sempre investiu em evolução, vindo a se atualizar nas oportunidades tecnológicas e de usabilidade.

Abstract in English:

ABSTRACT OBJECTIVE: Contextualize the adherence to the Prontuário Eletrônico do Cidadão (PEC – Citizen's Electronic Health Record) by Brazilian municipalities and the evolution of the electronic strategy of the Unified Health System (e-SUS) for Primary Healthcare (PHC) during its 10 years. METHODS: This descriptive study added information on adherence to the use of medical records extracted from the database of the Secretaria de Atenção Primária à Saúde (SAPS– Primary Healthcare Secretary) of the Federal Government between 2017 and 2022. We analized the number of computerized basic healthcare units that used some electronic medical records, the number of those that used simplified data collection (SDC), and those that implemented the citizen's electronic health record (PEC) in the same period. A descriptive synthesis of the functionalities and modules implemented in the system during its 10 years of development was also carried out. RESULTS: The adherence of Brazilian municipalities to the PEC has grown exponentially in the last five years, going from 8,930 healthcare units in 2017 to 26,091 in 2022. As expected, while the main functionalities and improvements developed in this decade sought to implement new flows and modules of administrative, clinical care, and care management processes and health service administration, improving aspects of usability and technological infrastructure of the application architecture was also crucial for the success of the system. CONCLUSIONS: In 2023, the milestone of a decade will be celebrated since the beginning of health records implementation by Brazilian municipalities, marked by technological and infrastructure challenges and improvements and new functionalities that highlight the technological evolution of the e-SUS PHC system and strategy. Despite many other tools, the PEC is arguably Brazil's leading electronic medical record today, as it has always invested in evolution, updating itself in technological and usability opportunities.

Abstract in Portuguese:

RESUMO INTRODUÇÃO O câncer de pulmão (CP) é um relevante problema de saúde pública no Brasil e no mundo, dada sua alta incidência e mortalidade. Assim, objetiva-se analisar a distribuição do tabagismo e da carga tabágica segundo características sociodemográficas e disparidades no acesso, no tratamento e na mortalidade por CP no Brasil, em 2013 e 2019. MÉTODO Estudo retrospectivo de triangulação de fontes de dados de abrangência nacional: a) análise da distribuição do tabagismo, baseada na Pesquisa Nacional de Saúde (PNS); b) investigação dos registros de CP, via Registros Hospitalares de Câncer (RHC); e c) distribuição da mortalidade por CP, no Sistema de Informação sobre Mortalidade (SIM). RESULTADOS Verificou-se redução do percentual de pessoas que nunca fumaram de 2013 (68,5%) para 2019 (60,2%), assim como da carga tabágica (anos-maço). Esta foi observada maior em homens em pessoas de faixas etárias mais avançadas e de menor escolaridade. Em relação aos pacientes registrados no RHC, a entrada no serviço de saúde se dá a partir de 50 anos, e apenas 19% nunca fumaram. Ao passo que os fumantes na população são majoritariamente pardos, os pacientes no RHC são em maioria brancos. Quanto ao estadiamento inicial (I e II), é mais frequente em pessoas brancas e que nunca fumaram. A taxa de mortalidade apresentou variação de 1,00, para pessoas com ensino superior, a 3,36, entre pessoas sem instrução, assim como pessoas brancas têm uma taxa de mortalidade três vezes maior que a de pessoas negras e pardas. CONCLUSÃO Este artigo apontou relevantes disparidades sociodemográficas no acesso ao diagnóstico, tratamento e mortalidade do CP. Assim, recomenda-se: fortalecer o Registro de Câncer de Base Populacional; desenvolver e implementar estratégia de screening de CP no Brasil, uma vez que a realização de estratégias de prevenção e diagnóstico precoce combinadas funcionam melhor no controle da mortalidade pela doença; e investimento contínuo nas políticas de prevenção e controle do tabagismo.

Abstract in English:

ABSTRACT INTRODUCTION Lung cancer (LC) is a relevant public health problem in Brazil and worldwide, given its high incidence and mortality. Thus, the objective of this study is to analyze the distribution of smoking and smoking status according to sociodemographic characteristics and disparities in access, treatment, and mortality due to LC in Brazil in 2013 and 2019. METHOD Retrospective study of triangulation of national data sources: a) analysis of the distribution of smoking, based on the National Survey of Health (PNS); b) investigation of LC records via Hospital-based Cancer Registry (HCR); and c) distribution of mortality due to LC in the Mortality Information System (SIM). RESULTS There was a decrease in the percentage of people who had never smoked from 2013 (68.5%) to 2019 (60.2%) and in smoking history (pack-years). This was observed to be greater in men, people of older age groups, and those with less education. Concerning patients registered in the HCR, entry into the healthcare service occurs at the age of 50, and only 19% have never smoked. While smokers in the population are mainly Mixed-race, patients in the HCR are primarily White. As for the initial stage (I and II), it is more common in White people and people who have never smoked. The mortality rate varied from 1.00 for people with higher education to 3.36 for people without education. Furthermore, White people have a mortality rate three times higher than that of Black and mixed-race people. CONCLUSION This article highlighted relevant sociodemographic disparities in access to LC diagnosis, treatment, and mortality. Therefore, the recommendation is to strengthen the Population-Based Cancer Registry and develop and implement a nationwide LC screening strategy in Brazil since combined prevention and early diagnosis strategies work better in controlling mortality from the disease and continued investment in tobacco prevention and control policies.

Abstract in Portuguese:

RESUMO OBJETIVO Identificar os padrões espaciais da qualidade da estrutura dos serviços de atenção primária à saúde e do processo de trabalho das equipes e seus efeitos na mortalidade infantil no Brasil. MÉTODOS Estudo ecológico de agregados espaciais, empregando como unidade de análise os 5.570 municípios do Brasil. Foram utilizados bancos de dados secundários do Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-AB), do Sistema de Informação de Mortalidade (SIM) e do Sistema de Informações de Nascidos Vivos (SINASC). Em 2018, a taxa de mortalidade infantil foi o desfecho do estudo, e as variáveis de exposição foram a proporção de unidade básica de saúde (UBS) com estrutura e processo de trabalho adequados. Os índices de Moran global e local foram usados para avaliar o grau de dependência e a autocorrelação espacial. Utilizou-se regressão linear espacial para análise de dados. RESULTADOS Em 2018, no Brasil, a taxa de mortalidade infantil foi de 12,4/1.000 nascidos vivos, variando de 10,6/1.000 e 11,2/1.000 no Sul e no Sudeste, respectivamente, até 14,1/1.000 e 14,5/1.000, nas regiões Nordeste e Norte, respectivamente. A proporção de equipes com processo de trabalho adequado (β = - 3,13) e a de unidades básicas de saúde com estrutura adequada (β = - 0,34) foram associadas à redução da taxa de mortalidade infantil. Observou-se autocorrelação espacial entre as taxas de mortalidade infantil médias suavizadas e indicadores da estrutura dos serviços de atenção primária à saúde e do processo de trabalho das equipes, com valores mais elevados no Norte e no Nordeste do Brasil. CONCLUSÕES Existe relação entre a estrutura dos serviços de atenção primária à saúde e o processo de trabalho das equipes com a taxa de mortalidade infantil. Neste sentido, o investimento na qualificação da atenção à saúde no âmbito da atenção primária à saúde pode impactar na redução da taxa de mortalidade infantil e na melhoria da atenção à saúde infantil.

Abstract in English:

ABSTRACT OBJECTIVE To identify the spatial patterns of the quality of the structure of primary health care services and the teams’ work process and their effects on infant mortality in Brazil. METHODS An ecological study of spatial aggregates, using the 5,570 municipalities in Brazil as the unit of analysis. Secondary databases from the Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-AB – National Program for Improving Access and Quality of Primary Care), the Mortality Information System (SIM), and the Live Birth Information System (SINASC) were used. In 2018, the infant mortality rate was the outcome of the study, and the exposure variables were the proportion of basic health units (BHU) with adequate structure and work processes. Global and local Moran’s indices were used to evaluate the degree of dependence and spatial autocorrelation. Spatial linear regression was used for data analysis. RESULTS In 2018, in Brazil, the infant mortality rate was 12.4/1,000 live births, ranging from 10.6/1,000 and 11.2/1,000 in the South and Southeast, respectively, to 14.1/1,000 and 14.5/1,000 in the Northeast and North regions, respectively. The proportion of teams with an adequate work process (β = −3.13) and the proportion of basic health units with an adequate structure (β = −0.34) were associated with a reduction in the infant mortality rate. Spatial autocorrelation was observed between smoothed mean infant mortality rates and indicators of the structure of primary health care services and the team’s work process, with higher values in the North and Northeast of Brazil. CONCLUSIONS There is a relationship between the structure of primary health care services and the teams’ work process with the infant mortality rate. In this sense, investment in the qualification of health care within the scope of primary health care can have an impact on reducing the infant mortality rate and improving child health care.

Abstract in English:

ABSTRACT OBJECTIVE To identify the prevalence of contamination by pesticides and their metabolites in the milk of lactating mothers in Latin America. METHODS In this systematic review, the PubMed, LILACS, Embase, and Scopus databases were searched up to January 2022 to identify observational studies. The Mendeley software was used to manage these references. The risk of bias assessment was evaluated according to the checklist for prevalence studies and writing design, by the Prisma guidelines. RESULTS This study retrieved 1835 references and analyzed 49 studies. 69.38% of the analyzed studies found a 100% prevalence of breast milk contamination by pesticides among their sample. Main pesticides include dichlorodiphenyltrichloroethane (DDT) and its isomers (75.51%), followed by the metabolite dichlorodiphenyldichloroethylene (DDE) (69.38%) and hexachlorocyclohexane (HCH) (46.93%). This study categorized most (65.30%) studies as having a low risk of bias. CONCLUSIONS This review shows a high prevalence of pesticide contamination in the breast milk of Latin American women. Further investigations should be carried out to assess contamination levels in breast milk and the possible effects of these substances on maternal and child health.

Abstract in English:

ABSTRACT OBJECTIVE To assess regional and national mortality and years of life lost (YLL) related to adverse drug events in Brazil. METHODS This is an ecological study in which death records from 2009 to 2018 from the Mortality Information System were analyzed. Codes from the International Classification of Diseases 10th revision (ICD-10) that indicated drugs as the cause of death were identified. The number of deaths and the YLL due to adverse drug events were obtained. Crude, age- and gender-specific, and age-adjusted mortality rates and YLL rates per 100,000 inhabitants were formed by year, age group, gender, and Brazilian Federative Unit. Rate ratios were calculated by comparing rates from 2009 to 2018. A joinpoint regression model was applied for temporal analysis. RESULTS For the selected ICD-10 codes, a total of 95,231 deaths and 2,843,413 YLL were recorded. Mortality rates from adverse drug events increased by a mean of 2.5% per year, and YLL rates increased by 3.7%. Increases in rates were observed in almost all age groups for both genders. Variations in rates were found between Federative Units, with the highest age-adjusted mortality and YLL rates occurring in the Distrito Federal. CONCLUSIONS The numbers and rates of deaths and YLL increased during the study period, and variations in rates of deaths and YLL were observed between Brazilian Federative Units. Information on multiple causes of death from death certificates can be useful for quantifying adverse drug events and analyzing them geographically, by age and by gender.

Abstract in Portuguese:

RESUMO OBJETIVO Integrar os conceitos de Saúde Planetária e Big Data ao modelo de Donabedian, para avaliar o Programa de Combate à Dengue no estado de São Paulo. MÉTODOS Foram adotados métodos de Ciência de Dados para integração e análise de dados relacionados à dengue, agregando o contexto aos componentes de estrutura e de resultado do modelo de Donabedian. Esses dados, considerando o período de 2010 a 2019, foram coletados de fontes como Datasus, Instituto Brasileiro de Geografia e Estatística (IBGE), WorldClim e MapBiomas, e integrados em um Data Warehouse. Para a identificação de grupos com contextos similares, foi utilizado o algoritmo K-means. Em seguida, foram realizadas análises estatísticas e visualizações espaciais dos grupos, considerando variáveis socioeconômicas, demográficas, solo, estrutura de saúde e casos de dengue. RESULTADOS Com o uso das variáveis climáticas, o algoritmo K-means identificou quatro grupos de municípios com características similares. A comparação dos seus indicadores revelou certos padrões nos municípios com pior desempenho quanto aos resultados de casos de dengue. Embora tivessem melhores condições econômicas, eles tinham menor número médio de agentes comunitários e de unidades básicas de saúde por habitante. Dessa forma, as condições econômicas não refletiram em melhor estrutura de saúde nos três indicadores avaliados. Outra característica desses municípios é a urbanização. Os municípios de pior desempenho tinham maior taxa de população urbana e de modificações antrópicas relacionadas à urbanização. CONCLUSÕES Por meio desta metodologia, foi possível identificar importantes deficiências nas condições para a execução do programa de combate à dengue no estado de São Paulo. A integração de diversas bases de dados e a utilização de métodos de Ciência de Dados permitiram a avaliação do programa em larga escala, considerando o contexto em que as ações são executadas. Dessa forma, a gestão pública pode utilizar as informações coletadas para planejar ações e investir de acordo com as deficiências de cada local.

Abstract in English:

ABSTRACT OBJECTIVE This study aims to integrate the concepts of planetary health and big data into the Donabedian model to evaluate the Brazilian dengue control program in the state of São Paulo. METHODS Data science methods were used to integrate and analyze dengue-related data, adding context to the structure and outcome components of the Donabedian model. This data, considering the period from 2010 to 2019, was collected from sources such as Department of Informatics of the Unified Health System (DATASUS), the Brazilian Institute of Geography and Statistics (IBGE), WorldClim, and MapBiomas. These data were integrated into a Data Warehouse. K-means algorithm was used to identify groups with similar contexts. Then, statistical analyses and spatial visualizations of the groups were performed, considering socioeconomic and demographic variables, soil, health structure, and dengue cases. OUTCOMES Using climate variables, the K-means algorithm identified four groups of municipalities with similar characteristics. The comparison of their indicators revealed certain patterns in the municipalities with the worst performance in terms of dengue case outcomes. Although presenting better economic conditions, these municipalities held a lower average number of community healthcare agents and basic health units per inhabitant. Thus, economic conditions did not reflect better health structure among the three studied indicators. Another characteristic of these municipalities is urbanization. The worst performing municipalities presented a higher rate of urban population and human activity related to urbanization. CONCLUSIONS This methodology identified important deficiencies in the implementation of the dengue control program in the state of São Paulo. The integration of several databases and the use of Data Science methods allowed the evaluation of the program on a large scale, considering the context in which activities are conducted. These data can be used by the public administration to plan actions and invest according to the deficiencies of each location.

Abstract in Portuguese:

RESUMO OBJETIVO Apresentar os resultados da análise de custos para a modalidade de consulta remota (teleconsulta) em comparação à consulta presencial, em pacientes com diabetes do tipo 2, no Sistema Único de Saúde (SUS) brasileiro, na cidade Joinville, Santa Catarina. Para além dos custos, sob a perspectiva do gestor local, o artigo também apresenta estimativas sob perspectiva do paciente, a partir dos custos de transporte associados a cada modalidade de consulta. MÉTODO Foram coletados dados de 246 consultas, remotas e presenciais, entre 2021 e 2023, no contexto de um ensaio clínico randomizado sobre o impacto da teleconsulta realizado na cidade de Joinville, SC. As teleconsultas foram realizadas em Unidades Básicas de Saúde (UBS) e as consultas presenciais no Centro de Saúde Especializada. Para o cálculo dos custos, foi utilizado o método de custos baseado em tempo e atividade (TDABC) e, para o cálculo dos custos relativos aos transportes dos pacientes, foram coletados dados diretamente com os participantes da pesquisa. Foram analisados e comparados descritivamente os custos médios e o tempo de realização de cada modalidade de consulta em diferentes cenários e perspectivas. RESULTADOS Considerando apenas a perspectiva do gestor local do SUS, os custos para a realização da teleconsulta se mostraram 4,5% maiores do que para uma consulta presencial. Contudo, quando considerados os custos de transporte associados a cada paciente, o valor estimado da consulta presencial passa a ser 7,7% maior e, no caso de consultas em outros municípios, 15% maior do que a teleconsulta. CONCLUSÃO Os resultados demonstram que a incorporação da teleconsulta dentro do SUS pode trazer vantagens econômicas, a depender da perspectiva e do cenário considerado, além de ser uma estratégia com potencial para aumentar o acesso à atenção especializada na rede pública.

Abstract in English:

ABSTRACT OBJECTIVE To present the results of a cost analysis of remote consultations (teleconsultations) compared to in-person consultations for patients with type 2 diabetes, in the Brazilian public healthcare system (SUS) in the city of Joinville, Santa Catarina (SC). In addition to the costs from the local manager’s perspective, the article also presents estimates from the patient’s perspective, based on the transportation costs associated with each type of consultation. METHOD Data were collected from 246 consultations, both remote and in-person, between 2021 and 2023, in the context of a randomized clinical trial on the impact of teleconsultation carried out in the city of Joinville, SC. Teleconsultations were carried out at Primary Health Units (PHU) and in-person consultations at the Specialized Health Center. The consultation costs were calculate by the method time and activity-based costing (TDABC), and for the estimate of transportation costs data was collected directly from the research participants . The mean costs and time required to carry out each type of consultation in different scenarios and perspectives were analyzed and compared descriptively. RESULTS Considering only the local SUS manager’s perspective, the costs for carrying out a teleconsultation were 4.5% higher than for an in-person consultation. However, when considering the transportation costs associated with each patient, the estimated value of the in-person consultation becomes 7.7% higher and, in the case of consultations in other municipalities, 15% higher than the teleconsultation. CONCLUSION The results demonstrate that the incorporation of teleconsultation within the SUS can bring economic advantages depending on the perspective and scenario considered, in addition to being a strategy with the potential to increase access to specialized care in the public network.

Abstract in Portuguese:

RESUMO A pandemia de covid-19 gerou um numeroso volume de produções científicas com diferentes níveis de qualidade. A velocidade com que o conhecimento era produzido e compartilhado a nível mundial impôs à gestão em saúde o desafio de buscar meios de identificar as melhores evidências disponíveis para subsidiar suas decisões. Em resposta a este desafio, o Departamento de Ciência e Tecnologia do Ministério da Saúde do Brasil estabeleceu um serviço para elaborar e disponibilizar conhecimento científico abordando questões prioritárias de saúde pública no cenário da pandemia. Entre os temas abordados estão tratamentos medicamentosos, medidas não farmacológicas, testagem, reinfecção e resposta imunológica, imunização, fisiopatologia, síndrome pós-covid e eventos adversos. Neste artigo, discute-se os pontos fortes e lições aprendidas, bem como os desafios e perspectivas que fornecem um exemplo real sobre como disponibilizar as melhores evidências científicas, em tempo hábil e de forma oportuna, para auxiliar o processo decisório durante uma emergência em saúde pública.

Abstract in English:

ABSTRACT The COVID-19 pandemic generated a large volume of scientific productions with different quality levels. The speed with which knowledge was produced and shared worldwide imposed on health management the challenge of seeking ways to identify the best available evidence to support its decisions. In response to this challenge, the Department of Science and Technology of the Brazilian Ministry of Health started offering a service to produce and provide scientific knowledge addressing priority public health issues in the pandemic scenario. Drug treatments, non-pharmacological measures, testing, reinfection and immunological response, immunization, pathophysiology, post-COVID syndrome and adverse events are among the topics covered. In this article, we discuss the strengths and lessons learned, as well as the challenges and perspectives that present a real example of how to offer the best scientific evidence in a timely manner in order to assist the decision-making process during a public health emergency.

Abstract in Portuguese:

RESUMO OBJETIVO Avaliar e comparar o protagonismo das equipes de Saúde Bucal (eSB) no processo de trabalho em equipe na Atenção Primária à Saúde (APS) ao longo de cinco anos, e estimar a magnitude das disparidades entre as macrorregiões brasileiras. MÉTODOS Estudo ecológico que utilizou dados secundários extraídos do Sistema de Informação em Saúde para a Atenção Básica (SISAB), de 2018 a 2022. Foram selecionados indicadores de matriz avaliativa previamente validada, calculados a partir dos registros na Ficha de Atividade Coletiva do grau de protagonismo das eSB nas reuniões de equipe, bem como do seu grau de organização em relação às pautas dos encontros. Foi realizada análise descritiva e da amplitude da variação dos indicadores ao longo do tempo, e também foi calculado o índice de disparidade para estimar e comparar a magnitude das diferenças entre as macrorregiões no ano de 2022. RESULTADOS No Brasil, entre 3,06% e 4,04% das reuniões de equipe foram lideradas por profissionais da eSB. No período, o Nordeste e o Sul foram as regiões que apresentaram maiores (3,71% a 4,88%) e menores proporções (1,21% a 2,48%), respectivamente. No período de 2018 a 2022, houve uma redução do indicador “grau de protagonismo das eSB” no Brasil e nas macrorregiões. Os temas mais frequentes em reuniões sob responsabilidade das eSB foram processo de trabalho (54,71% a 70,64%) e diagnóstico e monitoramento do território (33,49% a 54,48%). As maiores disparidades entre as regiões foram observadas para o indicador “grau de organização das eSB, em relação à discussão de caso e de projeto terapêutico singular”. CONCLUSÕES O protagonismo das eSB no processo de trabalho em equipe na APS é incipiente e apresenta disparidades regionais, o que desafia gestores e eSB para o rompimento do isolamento e da falta de integração, visando a oferta de atenção à saúde integral e de qualidade ao usuário do Sistema Único de Saúde (SUS).

Abstract in English:

ABSTRACT OBJECTIVE Evaluate and compare the protagonism of Oral Health teams (OHt) in the teamwork process in Primary Healthcare (PHC) over five years and estimate the magnitude of disparities between Brazilian macro-regions. METHODS Ecological study that used secondary data extracted from the Sistema de Informação em Saúde para a Atenção Básica (SISAB – Health Information System for Primary Healthcare) from 2018 to 2022. Indicators were selected from a previously validated evaluative matrix, calculated from records in the Collective Activity Form on the degree of OHt’s protagonism in team meetings and its degree of organization concerning the meeting agendas. A descriptive and amplitude analysis of the indicators’ variation over time was carried out, and the disparity index was also calculated to estimate and compare the magnitude of differences between macro-regions in 2022. RESULTS In Brazil, between 3.06% and 4.04% of team meetings were led by OHt professionals. The Northeast and South regions had the highest (3.71% to 4.88%) and lowest proportions (1.21% to 2.48%), respectively. From 2018 to 2022, there was a reduction in the indicator of the “degree of protagonism of the OHt” in Brazil and macro-regions. The most frequent topics in meetings under OHt’s responsibility were the work process (54.71% to 70.64%) and diagnosis and monitoring of the territory (33.49% to 54.48%). The most significant disparities between regions were observed for the indicator “degree of organization of the OHt concerning case discussion and singular therapeutic projects”. CONCLUSIONS The protagonism of the OHt in the teamwork process in PHC is incipient and presents regional disparities, which challenges managers and OHt to break isolation and lack of integration, aiming to offer comprehensive and quality healthcare to the user of the Unified Health System (SUS).

Abstract in Portuguese:

RESUMO OBJETIVO Analisar a distribuição e associação de fatores sociodemográficos e ocupacionais a acidentes de trabalho (AT) autorrelatados em uma amostra representativa da população brasileira, com ênfase na classe ocupacional, e examinar as diferenças de gênero nessa distribuição. MÉTODOS Estudo transversal de base populacional, com dados da Pesquisa Nacional de Saúde (PNS) de 2019, analisou as respostas de uma amostra de adultos com 18 anos ou mais de idade. Fatores associados a AT foram investigados por regressão logística binária e análise hierarquizada por meio de blocos (variáveis sociodemográficas e ocupacionais). O modelo final foi ajustado pelas variáveis de todos os blocos, adotando-se o nível de significância de 5%. Obtiveram-se os valores das razões de chance (RC) e respectivos intervalos de confiança. RESULTADOS Entre os participantes, 2,69% relataram ter sofrido AT, sendo mais alta a prevalência em homens (3,37%; IC95% 2,97–3,82%), se comparados às mulheres (1,86%; IC95% 1,55–2,23%). A análise identificou que faixa etária, trabalho noturno, jornada de trabalho e exposição a riscos laborais foram associados a AT, com destaque para as diferenças de gênero. A classe de trabalhadores manuais, tanto qualificados (RCmulheres = 2,87; IC95% 1,33–6,21 e RChomens = 2,46; IC95% 1,37–4,40) quanto não qualificados (RCmulheres = 2,55; IC95% 1,44–4,50 e RChomens = 3,70; IC95% 1,95–7,03), apresentaram maior chance de AT em comparação à classe de gerentes/profissionais. CONCLUSÃO Fatores ocupacionais contribuíram significativamente para o aumento na probabilidade de AT para homens e mulheres, com maior magnitude entre aqueles posicionados nos estratos inferiores da estrutura ocupacional. Os resultados obtidos são pistas para a elaboração de ações de prevenção de AT.

Abstract in English:

ABSTRACT OBJECTIVE To analyze the distribution and association of sociodemographic and occupational factors with self-reported work accidents (WA) in a representative sample of the Brazilian population, with emphasis on occupational class, and to examine gender differences in this distribution. METHODS A population-based cross-sectional study, using data from the 2019 National Health Survey (PNS), analyzed the responses of a sample of adults aged 18 or over. Factors associated with WA were investigated using binary logistic regression and hierarchical analysis using blocks (sociodemographic and occupational variables). The final model was adjusted by variables from all blocks, adopting a significance level of 5%. The values of odds ratios (OR) and respective confidence intervals were obtained. RESULTS Among the participants, 2.69% reported having suffered a WA, with a higher prevalence in men (3.37%; 95%CI 2.97–3.82%) than in women (1.86%; 95%CI 1.55–2.23%). The analysis identified that age group, night work, working hours, and exposure to occupational risks were associated with WA, with emphasis on gender differences. The class of manual workers, both qualified (ORwomen = 2.87; 95%CI 1.33–6.21 and ORmen = 2.46; 95%CI 1.37–4.40) and unskilled (ORwomen = 2.55; 95%CI 1.44–4.50 and ORmen = 3.70; 95%CI 1.95–7.03), had a higher chance of WA than the class of managers/professionals. CONCLUSION Occupational factors contributed significantly to the increase in the probability of WA for men and women, with greater magnitude among those positioned in the lower strata of the occupational structure. The results obtained are clues for working out WA prevention actions.

Abstract in English:

ABSTRACT OBJECTIVE To describe the methodological challenges and strategies of a web survey on the working conditions and health among delivery workers. METHODS The study population consisted of Brazilian delivery workers operating in the national territory. Procedures include building solid and ongoing collaboration with worker representatives and conducting a four-month data collection from February to May 2022, sharing the link to the online questionnaire on social media such as social networks (Facebook, Instagram) and messaging apps (WhatsApp, Telegram). RESULTS The recruitment of 41 leaders or influencers of delivery workers increased the dissemination of the study, some of whom participated in the consensual validation of the questionnaire; the production of content for social media for the dissemination of the questionnaire link on social networks and applications, and the in-person dissemination of the study at the delivery workers’ meeting points during the workday played a fundamental role, totaling around 132 hours in 45 shifts. The strategies adopted for data collection with a hybrid approach to dissemination made it possible to carry out the web survey. After four months of the web survey, 564 delivery workers, 543 men and 18 women, responded to the online questionnaire. CONCLUSION The web survey presented methodological strategies to overcome the challenge of reaching workers, including hybrid work, to increase the participation of workers, on whom epidemiological research is still scarce.

Abstract in English:

ABSTRACT OBJECTIVE To evaluate, using spatial analysis, the occurrence of American Cutaneous Leishmaniasis (ACL) and analyze its association with the municipal human development index (MHDI) and deforestation in the state of Amazonas, Brazil, from 2016 to 2020. METHODS This ecological study, carried out from January 2016 to December 2020, included the 62 municipalities of the state of Amazonas. The incidence rate of ACL was determined in space and time. Using Multiple Linear Regression by Ordinary Least Squares (OLS) and Spatial Autoregressive Regression (SAR) models, the relationship between incidence rates and Human Development Index (HDI) and deforestation was analyzed., The high- and low-risk clusters were identified by employing the Getis-Ord Gi* statistic. RESULTS A total of 7,499 cases of ACL were registered in all 62 municipalities in the state. Most cases were in male (n=5,924; 79.24%), with the greatest frequency in the population aged from 20 to 39 years (n=3,356; 44.7%). The incidence rate in the state of Amazonas was 7.34 cases per 100,000 inhabitants-year, with the municipalities of Rio Preto da Eva and Presidente Figueiredo showing the highest rates (1,377.5 and 817.5 cases per 100,000 population-year, respectively). The ACL cases were clustered into specific areas related to those municipalities with the highest incidence rates. The SAR model revealed a positive relationship between ACL and deforestation. CONCLUSIONS The occurrence of ACL was evident in a variety of patterns in the state of Amazonas; the high incidence rates and persistence of this disease in this state were linked to deforestation. The temporal distribution showed variations in the incidence rates during each year. Our results can help optimize the measures needed to prevent and control this disease in the state.

Abstract in Portuguese:

RESUMO OBJETIVO Analisar a geoespacialização da coinfecção tuberculose-HIV no Brasil, de 2010 a 2021, e a correlação com indicadores socioeconômicos, habitacionais e sanitários. MÉTODOS Estudo ecológico dos municípios e estados brasileiros, com dados dos sistemas de informação do HIV e da tuberculose, previamente relacionados pelo Ministério da Saúde. Foram calculados os coeficientes brutos e suavizados pelo método bayesiano empírico local de incidência da coinfecção, por 100 mil habitantes, na população entre 18 e 59 anos. Empregaram-se os índices de Moran univariado (identificação de clusters) e bivariado (correlação com 20 indicadores). RESULTADOS Foram registrados 122.223 casos de coinfecção no Brasil, de 2010 a 2021, com coeficiente médio de 8,30/100 mil. As regiões Sul (11,44/100 mil) e Norte (9,93/100 mil) concentraram a maior carga das infecções. Houve queda dos coeficientes no Brasil, em todas as regiões, nos anos de covid-19 (2020 e 2021). Os maiores coeficientes foram visualizados nos municípios do Rio Grande do Sul, do Mato Grosso do Sul e do Amazonas, com aglomerados alto-alto nas capitais, em regiões de fronteira e no litoral do país. Os municípios pertencentes aos estados de Minas Gerais, da Bahia, do Paraná e do Piauí apresentaram clusters baixo-baixo. Houve correlação direta com os índices de desenvolvimento humano e as taxas de aids, bem como indireta com a proporção de pobres ou vulneráveis à pobreza e o índice de Gini. CONCLUSÕES A análise espacial da coinfecção tuberculose-HIV demonstrou heterogeneidade no território brasileiro e comportamento constante ao longo do período, revelando clusters com municípios de alta carga, principalmente nos grandes centros urbanos e nos estados com ocorrência elevada do HIV e/ou da tuberculose. Esses achados, além de trazerem um alerta para os efeitos da pandemia da covid-19, podem incorporar o planejamento estratégico para o controle da coinfecção, visando à eliminação dessas infecções como problemas de saúde pública até 2030.

Abstract in English:

ABSTRACT OBJECTIVE To analyze the geospatialization of tuberculosis-HIV coinfection in Brazil, from 2010 to 2021, and the correlation with socioeconomic, housing, and health indicators. METHODS An ecological study of Brazilian municipalities and states, with data from HIV and tuberculosis information systems, previously reported by the Ministry of Health. The crude and smoothed coefficients were calculated by the local empirical Bayesian method of incidence of coinfection per 100,000 inhabitants in the population aged between 18 and 59 years. Univariate (identification of clusters) and bivariate (correlation with 20 indicators) Moran’s indices were used. RESULTS A total of 122,223 cases of coinfection were registered in Brazil from 2010 to 2021, with a mean coefficient of 8.30/100,000. The South (11.44/100,000) and North (9.93/100,000) regions concentrated the highest burden of infections. The coefficients dropped in Brazil, in all regions, in the years of covid-19 (2020 and 2021). The highest coefficients were observed in the municipalities of the states of Rio Grande do Sul, Mato Grosso do Sul, and Amazonas, with high-high clusters in the capitals, border regions, coast of the country. The municipalities belonging to the states of Minas Gerais, Bahia, Paraná, and Piauí showed low-low clusters. There was a direct correlation with human development indices and aids rates, as well as an indirect correlation with the proportion of poor or of those vulnerable to poverty and the Gini index. CONCLUSIONS The spatial analysis of tuberculosis-HIV coinfection showed heterogeneity in the Brazilian territory and constant behavior throughout the period, revealing clusters with high-burden municipalities, especially in large urban centers and in states with a high occurrence of HIV and/or tuberculosis. These findings, in addition to alerting to the effects of the covid-19 pandemic, can incorporate strategic planning for the control of coinfection, aiming to eliminate these infections as public health problems by 2030.

Abstract in Portuguese:

RESUMO OBJETIVO Analisar o impacto do projeto estadual de pesquisa-ação nos indicadores de imunização (coberturas vacinais – CV, homogeneidade de cobertura vacinal – HCV, taxa de abandono – TA e classificação de risco) antes e após a intervenção em municípios e Gerências Regionais de Saúde/Superintendências Regionais de Saúde (GRS/SRS) prioritários. MÉTODOS O projeto estadual de pesquisa-ação foi um ensaio clínico comunitário, do tipo antes-depois, realizado em 212 municípios pertencentes a oito GRS/SRS do estado de Minas Gerais, Brasil. Compuseram a amostra do estudo as SRS/GRS com tendência decrescente para a cobertura vacinal de rotina em crianças menores de 1 ano, no período de 2015 a 2020. Neste estudo, foram utilizados dados secundários de CV e TA de 10 imunobiológicos recomendados para crianças menores de 2 anos, no período de janeiro a dezembro de 2021 (período pré-intervenção, anterior ao projeto estadual de pesquisa-ação) e de janeiro a dezembro de 2022 (período pós-intervenção). As variáveis categóricas foram apresentadas em proporções e, inicialmente, realizou-se a comparação entre as de TA, HCV e a classificação de risco para a transmissão de doenças imunopreveníveis, segundo os dois períodos (2021 e 2022), utilizando-se o teste McNemar. RESULTADOS Observou-se um aumento de todos os indicadores de imunização após a realização do projeto de pesquisa-ação. No ano de 2021, 80,66% dos municípios do estado tiveram a classificação de risco para transmissão de doenças imunopreveníveis como “alto e muito alto risco”. Em 2022, o valor foi reduzido para 68,40%. CONCLUSÕES A classificação de risco para transmissão de doenças imunopreveníveis é um mecanismo importante para auxiliar os gestores na definição de prioridades. O projeto estadual de pesquisa-ação empregou um método que possibilitou a construção e a execução de planos de ação singulares a cada município, direcionando a melhoria dos indicadores de imunização no estado.

Abstract in English:

ABSTRACT OBJECTIVE Analyze the impact of the state research-action project on immunization indicators (vaccination coverage – VC, homogeneity of vaccination coverage – HVC, dropout rate – DR, and risk rating) before and after the intervention in municipalities and priority Regional Health Administrations/Regional Health Superintendencies (RHA/RHS). METHODS The state research-action project was a before-after community clinical trial conducted in 212 municipalities belonging to eight RHA/RHS in the state of Minas Gerais, Brazil. The study sample comprised RHA/RHS with a decreasing trend for routine vaccination coverage in children under one year from 2015 to 2020. This study used secondary VC and DR data from 10 immunobiologicals recommended for children younger than two years from January to December 2021 (pre-intervention period, prior to the state research-action project) and from January to December 2022 (post-intervention period). The categorical variables were presented in proportions, and initially, a comparison was made between those of DR, HVC, and the risk rating for the transmission of vaccine-preventable diseases, according to the two periods (2021 and 2022), using the McNemar test. RESULTS All immunization indicators increased after conducting the research-action project. In 2021, 80.66% of the state’s municipalities had a risk rating for the transmission of vaccine-preventable diseases as “high and very high.” In 2022, the value reduced to 68.40%. CONCLUSIONS Risk rating for the transmission of vaccine-preventable diseases is an important mechanism to assist managers in defining priorities. The state research-action project used a method that enabled the construction and execution of unique action plans for each municipality, directing the improvement of immunization indicators in the state.

Abstract in Portuguese:

RESUMO OBJETIVO Avaliar a associação entre a idade gestacional e as áreas verdes, áreas construídas urbanas e a concentração de material particulado 2,5 (MP2,5) em São Paulo, analisando a distribuição irregular dessas áreas e os níveis de poluição acima do recomendado. MÉTODOS A população utilizada no estudo foi a dos nascidos vivos no ano de 2012, com os dados do Sistema de Informações sobre Nascidos Vivo (Sinasc) na cidade de São Paulo. Por meio de imagens de satélites e realizando a classificação supervisionada, obtivemos a distribuição e quantidade de áreas verdes e de áreas construídas, na cidade de São Paulo, assim como as concentrações de MP2,5. Regressões logísticas foram utilizadas para obter possíveis associações. RESULTADOS Os resultados do estudo mostram que menor percentual de áreas verdes está associado significativamente com maior chance de prematuridade. Maior densidade de construção foi associada positivamente com a razão de chance de nascimento prematuro. Não encontramos resultados significativos entre a poluição do ar (MP2,5) e prematuridade. CONCLUSÕES Os resultados deste estudo demostraram que áreas mais verdes em relação às áreas menos verdes são menos associadas a nascimentos prematuros.

Abstract in English:

ABSTRACT OBJECTIVE To evaluate the association between gestational age and green areas, urban built areas, and the concentration of particulate matter 2.5 (PM2.5) in the city of São Paulo, analyzing the irregular distribution of these areas and pollution levels above the recommended level. METHODS The study population consisted of a cohort of live births from 2012, and data from the Live Birth Information System (Sinasc) of the city of São Paulo were used. Using satellite images and supervised classification, the distribution and quantity of green areas and built areas in the city of São Paulo was obtained, as well as the concentrations of PM2.5. Logistic regressions were used to obtain possible associations. RESULTS The results of the study show that a lower percentage of green areas is significantly associated with a higher chance of preterm births. A higher building density was positively associated with the odds ratio for preterm birth. We did not find any significant associations between air pollution (PM2.5) and preterm births. CONCLUSIONS The results of this study show that greener areas are less associated with preterm births when compared with less green areas.

Abstract in Portuguese:

RESUMO OBJETIVO Avaliar a efetividade das vacinas desenvolvidas contra a covid-19 na redução da mortalidade em pessoas internadas com síndrome respiratória aguda grave (SRAG) causada pelo SARS-CoV-2. MÉTODOS Trata-se de uma coorte retrospectiva que avaliou fatores de riscos e a efetividade do esquema vacinal com duas doses na redução da mortalidade de pessoas internadas por covid-19 no estado da Paraíba entre fevereiro e novembro de 2021. As variáveis explicativas foram situação vacinal, presença de comorbidades, características socioeconômicas e demográficas. Foram realizadas análises descritivas e regressão logística bivariada e multivariável. RESULTADOS A maior parte das internações e óbitos ocorreram até maio de 2021. O percentual de pacientes com esquema vacinal completo foi similar entre pacientes internados em hospitais públicos e privados e superior em residentes de municípios com menor desenvolvimento. A análise multivariável demonstrou que mulheres (OR = 0,896; IC95% 0,830–0,967) e pessoas internadas em hospitais privados (OR = 0,756; IC95% 0,679–0,842) apresentaram menor chance de morte. A presença de alguma comorbidade (OR = 1,627; IC95% 1,500–1,765) e idade ≥ 80 anos (OR = 7,426; IC95% 6,309–8,741) foram fatores de risco de óbito. Pacientes com esquema vacinal completo no momento da internação apresentaram uma chance 41,7% menor de morte (OR = 0,583; IC95% 0,501–0,679) por covid-19 na análise ajustada, quando comparados com pacientes não vacinados. CONCLUSÕES O estudo revela que a imunização foi efetiva na redução da chance de óbito por covid-19. Os resultados sugerem que uma maior cobertura vacinal no primeiro semestre de 2021 evitaria milhares de mortes no país.

Abstract in English:

ABSTRACT OBJECTIVE To evaluate the effectiveness of vaccines developed against covid-19 in reducing mortality in people hospitalized with severe acute respiratory syndrome (SARS) caused by SARS-CoV-2. METHODS This is a retrospective cohort that evaluated risk factors and the effectiveness of the two-dose vaccination schedule in reducing the mortality of people hospitalized for covid-19 in the state of Paraíba from February to November 2021. The explanatory variables were vaccination status, presence of comorbidities, socioeconomic and demographic characteristics. Descriptive analyses and bivariate and multivariable logistic regression were performed. RESULTS Most hospitalizations and deaths occurred until May 2021. The percentage of patients with a complete vaccination schedule was similar across patients admitted to public and private hospitals and higher in residents of less developed municipalities. Multivariable analysis demonstrated that women (OR = 0.896; 95%CI 0.830–0.967) and people admitted to private hospitals (OR = 0.756; 95%CI 0.679–0.842) were less likely to die. Presence of any comorbidity (OR = 1.627; 95%CI 1.500–1.765) and age ≥ 80 years (OR = 7.426; 95%CI 6.309–8.741) were risk factors for death. Patients with complete vaccination schedule at the time of admission were 41.7% less likely to die (OR = 0.583; 95% CI 0.501–0.679) from covid-19 in the adjusted analysis, as compared to unvaccinated patients. CONCLUSIONS The study reveals that immunization was effective in reducing the likelihood of death from covid-19. The results suggest that greater vaccination coverage in the first half of 2021 would prevent thousands of deaths in the country.

Abstract in Portuguese:

RESUMO OBJETIVO Investigar a correlação entre as vendas de dois medicamentos sem eficácia comprovada no tratamento de covid-19, ivermectina e cloroquina, e outras variáveis relevantes: pesquisas no Google®, número de tweets relacionados aos medicamentos, casos e óbitos decorrentes da covid-19. MÉTODOS A metodologia adotada neste estudo se divide em quatro partes: coleta de dados; processamento dos dados; análise exploratória; e análise de correlação. Foi utilizado o método de Spearman para obter as correlações cruzadas entre cada par de variáveis. RESULTADOS Os resultados mostram similaridade entre os comportamentos das variáveis. Os picos ocorreram em períodos iguais ou próximos. A análise exploratória dos dados apontou que houve falta de cloroquina no período correspondente ao início das divulgações sobre a aplicação desses medicamentos para o tratamento da covid-19. Ambos os medicamentos apresentaram correlação alta e estatisticamente significativa com as demais variáveis analisadas. Também foi observado que algumas delas apresentaram maior correlação com as vendas de medicamentos quando assumiram defasagem temporal de um mês. No caso da cloroquina, isso ocorreu com a variável óbitos. No caso da ivermectina, ocorreu com as variáveis número de tweets, casos e óbitos. CONCLUSÕES Os resultados observados contribuem para a tomada de decisão durante a gestão de crises por parte de governo, indústrias e comércios. Em momentos de crises, como observado durante a pandemia, as variáveis mostraram que são capazes de auxiliar na previsão de vendas, em especial o Google® e os tweets, que proporcionam uma análise em tempo real da situação. Acompanhar as redes sociais e mecanismos de busca permitiria detecção de uso pela população e melhor previsão de potenciais picos de demanda desses medicamentos.

Abstract in English:

ABSTRACT OBJECTIVE Assess the correlation between the sales of two drugs with no proven efficacy against covid-19, ivermectin and chloroquine, and other relevant variables, such as Google® searches, number of tweets related to these drugs, number of cases and deaths resulting from covid-19. METHODS The methodology adopted in this study has four stages: data collection, data processing, exploratory data analysis, and correlation analysis. Spearman’s method was used to obtain cross-correlations between each pair of variables. RESULTS The results show similar behaviors between variables. Peaks occurred in the same or near periods. The exploratory data analysis showed shortage of chloroquine in the period corresponding to the beginning of advertising for the application of these drugs against covid-19. Both drugs showed a high and statistically significant correlation with the other variables. Also, some of them showed a higher correlation with drug sales when we employed a one-month lag. In the case of chloroquine, this was observed for the number of deaths. In the case of ivermectin, this was observed for the number of tweets, cases, and deaths. CONCLUSIONS The results contribute to decision making in crisis management by governments, industries, and stores. In times of crisis, as observed during the covid-19 pandemic, some variables can help sales forecasting, especially Google® and tweets, which provide a real-time analysis of the situation. Monitoring social media platforms and search engines would allow the determination of drug use by the population and better prediction of potential peaks in the demand for these drugs.

Abstract in English:

ABSTRACT OBJECTIVE This study aims to propose a comprehensive alternative to the Bland-Altman plot method, addressing its limitations and providing a statistical framework for evaluating the equivalences of measurement techniques. This involves introducing an innovative three-step approach for assessing accuracy, precision, and agreement between techniques, which enhances objectivity in equivalence assessment. Additionally, the development of an R package that is easy to use enables researchers to efficiently analyze and interpret technique equivalences. METHODS Inferential statistics support for equivalence between measurement techniques was proposed in three nested tests. These were based on structural regressions with the goal to assess the equivalence of structural means (accuracy), the equivalence of structural variances (precision), and concordance with the structural bisector line (agreement in measurements obtained from the same subject), using analytical methods and robust approach by bootstrapping. To promote better understanding, graphical outputs following Bland and Altman’s principles were also implemented. RESULTS The performance of this method was shown and confronted by five data sets from previously published articles that used Bland and Altman’s method. One case demonstrated strict equivalence, three cases showed partial equivalence, and one showed poor equivalence. The developed R package containing open codes and data are available for free and with installation instructions at Harvard Dataverse at https://doi.org/10.7910/DVN/AGJPZH. CONCLUSION Although easy to communicate, the widely cited and applied Bland and Altman plot method is often misinterpreted, since it lacks suitable inferential statistical support. Common alternatives, such as Pearson’s correlation or ordinal least-square linear regression, also fail to locate the weakness of each measurement technique. It may be possible to test whether two techniques have full equivalence by preserving graphical communication, in accordance with Bland and Altman’s principles, but also adding robust and suitable inferential statistics. Decomposing equivalence into three features (accuracy, precision, and agreement) helps to locate the sources of the problem when fixing a new technique.

Abstract in English:

ABSTRACT OBJECTIVE To evaluate the evolution of the dietary patterns of adolescents in the northeast region of Brazil. METHODS Secondary analysis of data from the Pesquisa de Orçamentos Familiares (POF – Household Budget Surveys), collected by the Brazilian Institute of Geography and Statistics (IBGE) in the years 2008–2009 and 2017–2018. A total of 3,095 adolescents were evaluated in 2008–2009 and 3,015 in 2017–2018. Food consumption was assessed using two dietary records in 2008–2009 and two 24-hour recalls in 2017–2018, applied on non-consecutive days. Based on these data, principal components factor analysis (PCFA) was performed, followed by orthogonal rotation of the varimax type, to derive dietary patterns, stratified by sex. The results were described as means or percentage frequencies, with their respective 95% confidence intervals. RESULTS Three main dietary patterns were identified among adolescents from the northeast region of Brazil. Among boys, in 2008–2009, the patterns were called snacks, traditional Brazilian, and coffee; and in 2017–2018, traditional Brazilian, snacks, and mixed, in this order of representativeness of the group’s eating habits. Among female adolescents, in 2008–2009, the patterns were snacks, traditional Brazilian, and coffee; and in 2017–2018, traditional Brazilian, snacks, and processed meats. CONCLUSION The dietary patterns identified in 2008–2009 and 2017–2018 were similar in both genders; however, the snacks pattern, which explained most of the data variability in 2008–2009, was replaced by the traditional Brazilian.

Abstract in English:

ABSTRACT OBJECTIVE To describe the prevalence of contraindicated use of combined hormonal contraceptives, progesterone-only contraceptives, and intrauterine devices in mothers participating in the 2015 Pelotas Birth Cohort according to the WHO medical eligibility criteria. METHODS The biological mothers of children belonging to the 2015 Pelotas birth cohort who attended the 48-month follow-up were studied. The 48-month follow-up data were collected from January 1, 2019, to December 31, 2019. Contraindicated use of modern contraceptives was considered to occur when these women presented at least one of the contraindications for the use of modern contraceptives and were using these methods. The prevalence of contraindicated use was calculated according to each independent variable and their respective 95% confidence intervals (95%CI). RESULTS The analyzed sample consisted of 3,053 women who used any modern contraceptive method. The prevalence of contraindicated use of modern contraceptives totaled 25.9% (95%CI: 24.4–27.5). Combined hormonal contraceptives showed the highest prevalence of contraindicated use (52.1%; 95%CI: 49.3–54.8). The prevalence of contraindicated use of modern contraceptives methods was greater in women with family income between one and three minimum wages, a 25–30 kg/m2 body mass index, indication by a gynecologist for the used method, and purchasing the contraceptive method at a pharmacy. The higher the women’s education, the lower the prevalence of inappropriate use of modern contraceptives. CONCLUSION In total, one in four women used modern contraceptives despite showing at least one contraindication. Policies regarding women’s reproductive health should be strengthened.

Abstract in Portuguese:

RESUMO OBJETIVO Descrever e analisar a saudabilidade dos estabelecimentos com venda formal e informal de alimentos em terminais rodoviários da região metropolitana do Rio de Janeiro. MÉTODOS Realizou-se auditoria em 156 estabelecimentos formais e 127 pontos informais de venda de alimentos localizados em 14 terminais rodoviários das cinco cidades mais populosas da região metropolitana do Rio de Janeiro. Foram calculadas proporções de tipos de estabelecimentos e médias (IC95%) de indicadores de disponibilidade de alimentos nos ambientes formal e informal. Para o ambiente formal, foram descritos preços, proporções das formas de pagamento aceitas, dias e horários de funcionamento e categorias de alimentos com propaganda exposta. RESULTADOS A saudabilidade dos pontos de venda de alimentos nos terminais rodoviários era baixa (inferior a 36%). Em média, estavam disponíveis para compra 250% mais subgrupos de alimentos ultraprocessados do que in natura ou minimamente processados. Adquirir comida nesses locais era conveniente porque diversas formas de pagamento estavam disponíveis e os horários de funcionamento dos estabelecimentos acompanhavam os picos de movimentação. Além disso, 73,3% das propagandas se referiam a bebidas ultraprocessadas e o custo-benefício da compra de alimentos ultraprocessados era melhor que o de alimentos in natura ou minimamente processados. CONCLUSÃO O ambiente alimentar dos terminais rodoviários da região metropolitana do Rio de Janeiro promove uma alimentação não saudável. Políticas públicas de regulação devem se concentrar em iniciativas que limitem a ampla disponibilidade e publicidade de alimentos ultraprocessados nesses espaços de grande circulação de pessoas.

Abstract in English:

ABSTRACT PURPOSE To describe and analyze the healthiness of formal and informal food establishments in bus terminals of the metropolitan region of the state of Rio de Janeiro. METHOD An audit was conducted in 156 formal and 127 informal food establishments located in 14 bus terminals of the five most populous cities of the metropolitan region of Rio de Janeiro. Proportions of types of establishments and means (95%CI) of food availability indicators in formal and informal settings were calculated. For the formal setting, prices, proportions of accepted payment methods, days and hours of operation, and food categories with displayed advertising were described. RESULTS The healthiness of food establishments in bus terminals was low (less than 36%). On average, ultra-processed food subgroups were 250% more available for purchase than fresh or minimally processed food. Purchasing food at these places was convenient because several forms of payment were available, and the opening hours of the establishments followed the peaks of movement. In addition, 73.3% of the advertising referred to ultra-processed drinks, and the cost-benefit of buying ultra-processed food was better than fresh or minimally processed food. CONCLUSION The food environment of bus terminals in the metropolitan region of Rio de Janeiro promotes unhealthy eating. Regulatory public policies should focus on initiatives to limit the wide availability and advertising of ultra-processed food in spaces of great circulation of people.

Abstract in English:

ABSTRACT OBJECTIVES To evaluate the performance of geneXpert MTB/Rif versus conventional methods (bacilloscopy and culture) in the diagnosis of tuberculosis in a Central Public Health Laboratory (LACEN, Tocantins), Northern Brazil. METHODS Retrospective study, with information from 1,973 suspected cases of tuberculosis from patients treated from January 2015 to December 2020. RESULTS From the culture (reference standard), the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the geneXpert MTB/Rif were 100%, 97%, 74%, 100%, and 97%, respectively, against 85%, 98%, 80%, 98%, and 97% of bacilloscopy. CONCLUSIONS The geneXpert MTB/Rif performed similarly to culture and better than bacilloscopy. Although positive cases with negative culture should be evaluated with caution, its routine use is important for the early detection of tuberculosis.