Obesity and Associated Factors in Brazilian Adults: Systematic Review and Meta-Analysis of Representative Studies.

To review the literature and select population-based studies that are representative of Brazilian capitals or Brazil as a whole to estimate the prevalence of obesity among Brazilian adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used. The search was conducted in six databases and reference lists of included studies. We included observational studies but excluded interventional studies, reviews, in vitro studies, and editorials. The study population consisted of young adults and adults (18 to 59 years old). Adolescents, infants, children, the elderly, and pregnant women were excluded. The primary outcomes were the prevalence of obesity among Brazilian adults, both men and women. The secondary outcomes were factors associated with obesity. The meta-analysis was performed using Rstudio software, version 4.1.0, by using the 'Meta' package, version 5.0-0. The search strategy identified 5634 references, of which 19 studies and 21 national surveys were included in the meta-analysis. The pooled prevalence of obesity in Brazilian adults was 20.0% (95% CI: 14.0-25.0%) while in the capitals it was 17.0% (95% CI: 16.0-19.0%). Across the regions of Brazil, the prevalence ranged from 11.0% to 17.0%, with the highest frequency in the south. Increases in obesity prevalence were observed for both sexes in almost all periods, with consistently higher rates among women in most cases. The prevalence of obesity among Brazilian adults is high, with no statistically significant differences found in the subgroup analysis.

Adherence to antihypertensive drug treatment in Brazil: a systematic review and meta-analysis. / Adesão ao tratamento medicamentoso anti-hipertensivo no Brasil: revisão sistemática e meta-análise.

This article aims to evaluate the adherence to antihypertensive treatment prevalence in the Brazilian population based on peer-reviewed studies which used instruments exclusively designed and/or adapted for this purpose. A systematic review with meta-analysis based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was carried out in the BDENF, SciELO, Cuiden, PsycINFOe, CINAHL, Embase, LILACS, and MEDLINE databases, as well as the AgeLine, Google Scholar and ScienceDirect academic search engines. The protocol was registered with PROSPERO (CRD42021292689). Random effects models were used for a meta-analysis of the prevalence obtained from individual studies. A total of 104 studies were included in the meta-analysis on antihypertensive treatment in the Brazilian population, totaling 38,299 patients. The most used instrument was the four-item Morisky-Green Test (49.5%). The adherence prevalence estimated by the meta-analysis was 44.4% (95%CI: 39.12%-49.94%, I2 = 91.17, p < 0.001), showing high heterogeneity. The adherence to antihypertensive treatment prevalence found in national studies was unsatisfactory, demonstrating that this problem continues to be a major challenge.

O objetivo do artigo é avaliar a prevalência de adesão ao tratamento anti-hipertensivo na população brasileira, com base nos estudos revisados por pares, que utilizaram instrumentos elaborados e/ou adaptados exclusivamente para este fim. Revisão sistemática com meta-análise, baseada nas recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A busca foi realizada nas bases BDENF, SciELO, Cuiden, PsycINFOe, CINAHL, Embase, LILACS, MEDLINE, e nos buscadores acadêmicos AgeLine, Google Scholar e ScienceDirect. O protocolo foi registrado no PROSPERO (CRD42021292689). Modelos de efeitos aleatórios foram usados para meta-análise das prevalências obtidas dos estudos individuais. Incluíram-se 104 estudos na meta-análise sobre tratamento anti-hipertensivo na população brasileira, totalizando 38.299 pacientes. O instrumento mais utilizado foi o teste de Morisky-Green de quatro itens (49,5%). A prevalência de adesão estimada pela foi de 44,4% (IC95%: 39,12%-49,94%, I2 = 91,17, p < 0,001), apresentando alta heterogeneidade. A prevalência de adesão ao tratamento anti-hipertensivo encontrada nos estudos nacionais foi insatisfatória, demonstrando que essa problemática continua sendo um grande desafio.

Temporal trends in female firearm homicides across states in the Northeast of Brazil during the period 2000-2019. / Tendência temporal da mortalidade por homicídios femininos por arma de fogo nos estados da região Nordeste do Brasil no período 2000-2019.

This article aims to analyze temporal trends in female firearm homicides in the Northeast of Brazil during the period 2000-2019. We conducted an ecological study using data on firearm homicides of women aged 10 years and over obtained from the Mortality Information System. The population data were taken from the 2010 Census. Homicide rates were calculated after correcting the data to account for differences in the quality and coverage of death records. Trends were assessed using negative binomial regression and described using relative risk and p values. Average annual percentage changes in homicide rates were also calculated. The regional firearm homicide rate during the study period was 4.40 per 100,000 women. Rates were highest in the state of Alagoas (5.40), the 15-19 age group (5.84) and in public thoroughfares (1.58). Trends were upward across all states except Pernambuco, where they were downward, and Alagoas, where rates were stationary. The place of occurrence with the highest percentage increase in firearm homicides over the study period was public thoroughfares. Female firearm homicides showed an upward trend across most northeastern states.

O objetivo deste artigo é analisar a tendência temporal dos homicídios femininos perpetrados por arma de fogo nos estados nordestinos, no período de 2000 a 2019. Estudo ecológico, com dados de homicídios por arma de fogo em mulheres com 10 ou mais anos, registrados no Sistema de Informação Sobre Mortalidade. Os dados de mortalidade e os dados populacionais foram obtidos junto ao Departamento de Informática do Sistema Único de Saúde. Após a correção dos registros de óbito para qualidade e cobertura dos óbitos, as taxas de mortalidade foram calculadas Tendências foram avaliadas por regressão binomial negativa, classificadas de acordo com o valor do risco relativo e valor de p. Calculou-se a variação percentual anual média das taxas de mortalidade. A região apresentou 4,40 homicídios por arma de fogo por 100 mil mulheres no período do estudo, maiores coeficientes em Alagoas (5,40), na faixa etária de 15-19 anos (5,84), e via pública (1,58). As tendências foram ascendentes, com exceção de Pernambuco em que foi descendente, e estacionárias em Alagoas. Os homicídios por arma de fogo em via pública apresentaram maior percentual de aumento no período estudado. Observou-se tendência ascendente nos homicídios femininos perpetrados por arma de fogo na maioria dos estados nordestinos.

Adesão ao tratamento medicamentoso anti-hipertensivo no Brasil: revisão sistemática e meta-análise / Adherence to antihypertensive drug treatment in Brazil: a systematic review and meta-analysis

Resumo O objetivo do artigo é avaliar a prevalência de adesão ao tratamento anti-hipertensivo na população brasileira, com base nos estudos revisados por pares, que utilizaram instrumentos elaborados e/ou adaptados exclusivamente para este fim. Revisão sistemática com meta-análise, baseada nas recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A busca foi realizada nas bases BDENF, SciELO, Cuiden, PsycINFOe, CINAHL, Embase, LILACS, MEDLINE, e nos buscadores acadêmicos AgeLine, Google Scholar e ScienceDirect. O protocolo foi registrado no PROSPERO (CRD42021292689). Modelos de efeitos aleatórios foram usados para meta-análise das prevalências obtidas dos estudos individuais. Incluíram-se 104 estudos na meta-análise sobre tratamento anti-hipertensivo na população brasileira, totalizando 38.299 pacientes. O instrumento mais utilizado foi o teste de Morisky-Green de quatro itens (49,5%). A prevalência de adesão estimada pela foi de 44,4% (IC95%: 39,12%-49,94%, I2 = 91,17, p < 0,001), apresentando alta heterogeneidade. A prevalência de adesão ao tratamento anti-hipertensivo encontrada nos estudos nacionais foi insatisfatória, demonstrando que essa problemática continua sendo um grande desafio.

Abstract This article aims to evaluate the adherence to antihypertensive treatment prevalence in the Brazilian population based on peer-reviewed studies which used instruments exclusively designed and/or adapted for this purpose. A systematic review with meta-analysis based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was carried out in the BDENF, SciELO, Cuiden, PsycINFOe, CINAHL, Embase, LILACS, and MEDLINE databases, as well as the AgeLine, Google Scholar and ScienceDirect academic search engines. The protocol was registered with PROSPERO (CRD42021292689). Random effects models were used for a meta-analysis of the prevalence obtained from individual studies. A total of 104 studies were included in the meta-analysis on antihypertensive treatment in the Brazilian population, totaling 38,299 patients. The most used instrument was the four-item Morisky-Green Test (49.5%). The adherence prevalence estimated by the meta-analysis was 44.4% (95%CI: 39.12%-49.94%, I2 = 91.17, p < 0.001), showing high heterogeneity. The adherence to antihypertensive treatment prevalence found in national studies was unsatisfactory, demonstrating that this problem continues to be a major challenge.

The Role of Race in Deaths of Despair in Brazil: Is it a White People Problem?

BACKGROUND: A new paradigm has been discussed regarding the impact of economic cycles on the mortality pattern from specific causes. These causes are called deaths of despair, and they selectively impact specific demographic groups. Also, low- and middle-income countries are most affected due to their economic and social instability. In this sense, the objective of study was to compare the magnitude of disparity in deaths from despair according to sex, age, and race in Brazil. METHODS: We performed Poisson regression modeling to estimate the magnitude of the association between sex, age group, race, and deaths from despair. Also, we estimated the relationship of time as a proxy of economic crisis phase and deaths of despair. RESULTS: We found an association between mortality from despair and male sex (PR = 6.15, 95%CI 6.09-6.22); emphasis on the age groups from 40 to 49 years old (PR = 2.45, 95% CI 2.41-2.48) and 50 to 59 years old (PR = 2.39, 95% CI 2.36-2.43); and brown (PR = 1.21, 95% CI 1.20-1.22) and black race (PR = 1.36, 95% CI 1.34-1.37). CONCLUSIONS: The present study preliminarily presents the effect of the economic crisis and mortality in the population, with demographic differences. Association with race was opposite to that verified in the original study in the USA, which suggests that this variable should be analyzed in the light of structural context.

Depressive symptoms and associated factors among travestis and transsexuals: a cross-sectional study.

OBJECTIVES: to estimate the prevalence of depressive levels and their associated factors among transvestite and transsexual individuals. METHODS: this cross-sectional study involved 58 participants assisted by non-governmental organizations. The Beck Depression Inventory was utilized to assess levels of depression, complemented by a sociodemographic questionnaire and a questionnaire on experiences of violence. Data were analyzed using descriptive statistics and Poisson regression with robust variance. RESULTS: a prevalence of 27.6% (95% CI = 11.50-39.10) for moderate to severe levels of depression was observed. This prevalence was associated with being unmarried (PR = 1.19; 95% CI = 1.10-1.28) and experiencing violence in healthcare services (PR = 2.30; 95% CI = 1.10-4.81). CONCLUSIONS: the absence of a partner and experiences of violence in healthcare settings negatively impacted mental health, leading to an increased prevalence of depressive symptoms among transvestite and transsexual individuals. Advocating for transgender rights and providing ongoing education in health care for professionals are critical strategies in promoting the mental health of this population.

Effect of a Structured Multilevel Telehealth Service on Hospital Admissions and Mortality During COVID-19 in a Resource-Limited Region in Brazil: Retrospective Cohort Study.

BACKGROUND: The COVID-19 pandemic represented a great stimulus for the adoption of telehealth and many initiatives in this field have emerged worldwide. However, despite this massive growth, data addressing the effectiveness of telehealth with respect to clinical outcomes remain scarce. OBJECTIVE: The aim of this study was to evaluate the impact of the adoption of a structured multilevel telehealth service on hospital admissions during the acute illness course and the mortality of adult patients with flu syndrome in the context of the COVID-19 pandemic. METHODS: A retrospective cohort study was performed in two Brazilian cities where a public COVID-19 telehealth service (TeleCOVID-MG) was deployed. TeleCOVID-MG was a structured multilevel telehealth service, including (1) first response and risk stratification through a chatbot software or phone call center, (2) teleconsultations with nurses and medical doctors, and (3) a telemonitoring system. For this analysis, we included data of adult patients registered in the Flu Syndrome notification databases who were diagnosed with flu syndrome between June 1, 2020, and May 31, 2021. The exposed group comprised patients with flu syndrome who used TeleCOVID-MG at least once during the illness course and the control group comprised patients who did not use this telehealth service during the respiratory illness course. Sociodemographic characteristics, comorbidities, and clinical outcomes data were extracted from the Brazilian official databases for flu syndrome, Severe Acute Respiratory Syndrome (due to any respiratory virus), and mortality. Models for the clinical outcomes were estimated by logistic regression. RESULTS: The final study population comprised 82,182 adult patients with a valid registry in the Flu Syndrome notification system. When compared to patients who did not use the service (n=67,689, 82.4%), patients supported by TeleCOVID-MG (n=14,493, 17.6%) had a lower chance of hospitalization during the acute respiratory illness course, even after adjusting for sociodemographic characteristics and underlying medical conditions (odds ratio [OR] 0.82, 95% CI 0.71-0.94; P=.005). No difference in mortality was observed between groups (OR 0.99, 95% CI 0.86-1.12; P=.83). CONCLUSIONS: A telehealth service applied on a large scale in a limited-resource region to tackle COVID-19 was related to reduced hospitalizations without increasing the mortality rate. Quality health care using inexpensive and readily available telehealth and digital health tools may be delivered in areas with limited resources and should be considered as a potential and valuable health care strategy. The success of a telehealth initiative relies on a partnership between the involved stakeholders to define the roles and responsibilities; set an alignment between the different modalities and levels of health care; and address the usual drawbacks related to the implementation process, such as infrastructure and accessibility issues.

[Social inequalities in the diagnosis of cervical cancer in Brazil: a hospital-based study]. / Desigualdades sociais no diagnóstico do câncer do colo do útero no Brasil: um estudo de base hospitalar.

The scope of this study is to analyze the prevalence of advanced stage diagnosis of cervical cancer and its association with individual and contextual socioeconomic and healthcare service indicators in Brazil. A cross-sectional study was conducted using cervical cancer cases in women aged 18 to 99 years, from 2006 to 2015, extracted from the Hospital Cancer Registry (HCR) Integrator. Contextual variables were collected from the Atlas of Human Development in Brazil; the National Registry of Health Institutions (NRHI); and the Outpatient Information System. Multilevel Poisson Regression with random intercept was used. The prevalence of advanced stage diagnosis was 48.4%, revealing an association with older age groups (PR 1.06; CI 1.01-1.10), black, brown, and indigenous race/skin color (PR 1.04; CI 1.01-1.07), lower levels of schooling (PR 1.28; CI 1.16-1.40), no marital partner (PR 1.10; CI 1.07-1.13), public referral to the health service (PR 1.07; CI 1.03-1.11), and lower rates of cytological examination (PR 1.08; CI 1.01-1.14). The results reinforce the need for improvements in the national cervical cancer prevention program in areas with low coverage of oncotic cytology.

O estudo visa analisar a prevalência de estadiamento avançado ao diagnóstico do câncer do colo do útero e sua associação com indicadores individuais e contextuais socioeconômicos e de oferta de serviços de saúde no Brasil. Estudo transversal, realizado com casos de câncer do colo do útero em mulheres de 18 a 99 anos, no período de 2006 a 2015, extraídos do Integrador de Registros Hospitalares de Câncer. Variáveis contextuais foram coletadas no Atlas do Desenvolvimento Humano, no Cadastro Nacional de Estabelecimentos de Saúde e no Sistema de Informações Ambulatoriais. Usou-se o modelo de regressão de Poisson multinível com intercepto aleatório. A prevalência de diagnóstico em estádio avançado foi de 48,4%, apresentando associação com idades mais avançadas (RP 1,06; IC 1,01-1,10), raça/cor da pele preta, parda e indígena (RP 1,04; IC 1,01-1,07), menores níveis de escolaridade (RP 1,28; IC 1,16-1,40), ausência de parceiro conjugal (RP 1,10; IC 1,07-1,13), encaminhamento do tipo público ao serviço de saúde (RP 1,07; IC 1,03-1,11) e menor taxa de realização de exame citopatológico (RP 1,08; IC 1,01-1,14). Os resultados reforçam a necessidade de melhorias no programa nacional de prevenção do câncer do colo do útero em áreas com baixa cobertura da citologia oncótica.

Desigualdades sociais no diagnóstico do câncer do colo do útero no Brasil: um estudo de base hospitalar / Social inequalities in the diagnosis of cervical cancer in Brazil: a hospital-based study

Resumo O estudo visa analisar a prevalência de estadiamento avançado ao diagnóstico do câncer do colo do útero e sua associação com indicadores individuais e contextuais socioeconômicos e de oferta de serviços de saúde no Brasil. Estudo transversal, realizado com casos de câncer do colo do útero em mulheres de 18 a 99 anos, no período de 2006 a 2015, extraídos do Integrador de Registros Hospitalares de Câncer. Variáveis contextuais foram coletadas no Atlas do Desenvolvimento Humano, no Cadastro Nacional de Estabelecimentos de Saúde e no Sistema de Informações Ambulatoriais. Usou-se o modelo de regressão de Poisson multinível com intercepto aleatório. A prevalência de diagnóstico em estádio avançado foi de 48,4%, apresentando associação com idades mais avançadas (RP 1,06; IC 1,01-1,10), raça/cor da pele preta, parda e indígena (RP 1,04; IC 1,01-1,07), menores níveis de escolaridade (RP 1,28; IC 1,16-1,40), ausência de parceiro conjugal (RP 1,10; IC 1,07-1,13), encaminhamento do tipo público ao serviço de saúde (RP 1,07; IC 1,03-1,11) e menor taxa de realização de exame citopatológico (RP 1,08; IC 1,01-1,14). Os resultados reforçam a necessidade de melhorias no programa nacional de prevenção do câncer do colo do útero em áreas com baixa cobertura da citologia oncótica.

Abstract The scope of this study is to analyze the prevalence of advanced stage diagnosis of cervical cancer and its association with individual and contextual socioeconomic and healthcare service indicators in Brazil. A cross-sectional study was conducted using cervical cancer cases in women aged 18 to 99 years, from 2006 to 2015, extracted from the Hospital Cancer Registry (HCR) Integrator. Contextual variables were collected from the Atlas of Human Development in Brazil; the National Registry of Health Institutions (NRHI); and the Outpatient Information System. Multilevel Poisson Regression with random intercept was used. The prevalence of advanced stage diagnosis was 48.4%, revealing an association with older age groups (PR 1.06; CI 1.01-1.10), black, brown, and indigenous race/skin color (PR 1.04; CI 1.01-1.07), lower levels of schooling (PR 1.28; CI 1.16-1.40), no marital partner (PR 1.10; CI 1.07-1.13), public referral to the health service (PR 1.07; CI 1.03-1.11), and lower rates of cytological examination (PR 1.08; CI 1.01-1.14). The results reinforce the need for improvements in the national cervical cancer prevention program in areas with low coverage of oncotic cytology.

Socio-economic vulnerability and deaths of despair in Brazilian counties.

Over the past few years, there has been a progressive increase in premature deaths attributable to suicide, drug overdose, and alcohol-related liver disease that impact life expectancy. Regarding the relationship with contextual effects, the evidence is developing, especially in countries with a peripheral economy, as is the case of Brazil. We carried out an analysis aimed at estimating the relationship between socioeconomic insecurity and deaths due to despair in Brazilian cities. We used 5,570 counties' data to create clusters concerning socioeconomic development and then analyzed age-adjusted mortality rates (ASMR) from each of them and compared them using the ANOVA test. Cluster analysis generated two groups of Brazilian municipalities. DoD rates are consistently higher in the group that experiences more deprivation. However, considering differences between 2010 and 2019, the increase in rates was higher in the group with less deprivation experience (48.82 % vs. 39.53 %) We verified an existing gap between the clusters before the beginning of economic stagnation in 2010 The gap between those two groups decreased from 20.58 % (p < 0.001) in 2010 to 14.03 % in 2019 (p = 0.034). The conjuncture of economic crises creates mortality differentials in certain population groups. Also, significant inequalities explain how causes of death from despair affect different subpopulations. Our first approach assessed this assumption, and we could check those differentials at an ecological level. Public policies should focus on reducing the difference in mortality from despair between higher and lower socioeconomic strata.

Depressive symptoms and associated factors among travestis and transsexuals: a cross-sectional study / Síntomas depresivos y factores asociados entre travestis y transexuales: estudio transversal / Sintomas depressivos e fatores associados entre travestis e transexuais: estudo transversal

ABSTRACT Objectives: to estimate the prevalence of depressive levels and their associated factors among transvestite and transsexual individuals. Methods: this cross-sectional study involved 58 participants assisted by non-governmental organizations. The Beck Depression Inventory was utilized to assess levels of depression, complemented by a sociodemographic questionnaire and a questionnaire on experiences of violence. Data were analyzed using descriptive statistics and Poisson regression with robust variance. Results: a prevalence of 27.6% (95% CI = 11.50-39.10) for moderate to severe levels of depression was observed. This prevalence was associated with being unmarried (PR = 1.19; 95% CI = 1.10-1.28) and experiencing violence in healthcare services (PR = 2.30; 95% CI = 1.10-4.81). Conclusions: the absence of a partner and experiences of violence in healthcare settings negatively impacted mental health, leading to an increased prevalence of depressive symptoms among transvestite and transsexual individuals. Advocating for transgender rights and providing ongoing education in health care for professionals are critical strategies in promoting the mental health of this population.

RESUMEN Objetivos: estimar la prevalencia de niveles depresivos y factores asociados entre personas travestis y transexuales. Métodos: estudio transversal con 58 participantes asistidos por organizaciones no gubernamentales. Se utilizó el Inventario de Depresión de Beck para la evaluación de los niveles depresivos y un cuestionario sociodemográfico y de experiencias de violencia. Los datos fueron analizados mediante estadística descriptiva y regresión de Poisson con varianza robusta. Resultados: se observó una prevalencia del 27,6% (IC95%=11,50-39,10) de niveles depresivos moderados a graves, asociada al estado civil soltero (RP=1,19; IC95%=1,10-1,28) y a la violencia en los servicios de salud (RP=2,30; IC95%=1,10-4,81). Conclusiones: vivir sin pareja y experimentar violencias en los servicios de salud perjudicaron la salud mental y aumentaron la prevalencia de síntomas depresivos entre personas travestis y transexuales. La defensa de los derechos de las personas trans y la educación permanente en salud para los profesionales son estrategias esenciales para promover la salud mental de esta población.

RESUMO Objetivos: estimar a prevalência de níveis depressivos e fatores associados entre pessoas travestis e transexuais. Métodos: estudo transversal com 58 participantes assistidos por organizações não governamentais. Utilizou-se o Beck Depression Inventory para avaliação dos níveis depressivos e um questionário sociodemográfico e de experiências de violência. Os dados foram analisados por meio de estatística descritiva e regressão de Poisson com variância robusta. Resultados: observou-se uma prevalência de 27,6% (IC95%=11,50-39,10) de níveis depressivos moderados a graves, associada ao estado civil solteiro (RP=1,19; IC95%=1,10-1,28) e à violência nos serviços de saúde (RP=2,30; IC95%=1,10-4,81). Conclusões: viver sem companheiro(a) e experienciar violências nos serviços de saúde prejudicaram a saúde mental e aumentaram a prevalência de sintomas depressivos entre pessoas travestis e transexuais. A defesa dos direitos de pessoas trans e a educação permanente em saúde para profissionais são estratégias essenciais para promover a saúde mental dessa população.

Tendência temporal da mortalidade por homicídios femininos por arma de fogo nos estados da região Nordeste do Brasil no período 2000-2019 / Temporal trends in female firearm homicides across states in the Northeast of Brazil during the period 2000-2019

Resumo O objetivo deste artigo é analisar a tendência temporal dos homicídios femininos perpetrados por arma de fogo nos estados nordestinos, no período de 2000 a 2019. Estudo ecológico, com dados de homicídios por arma de fogo em mulheres com 10 ou mais anos, registrados no Sistema de Informação Sobre Mortalidade. Os dados de mortalidade e os dados populacionais foram obtidos junto ao Departamento de Informática do Sistema Único de Saúde. Após a correção dos registros de óbito para qualidade e cobertura dos óbitos, as taxas de mortalidade foram calculadas Tendências foram avaliadas por regressão binomial negativa, classificadas de acordo com o valor do risco relativo e valor de p. Calculou-se a variação percentual anual média das taxas de mortalidade. A região apresentou 4,40 homicídios por arma de fogo por 100 mil mulheres no período do estudo, maiores coeficientes em Alagoas (5,40), na faixa etária de 15-19 anos (5,84), e via pública (1,58). As tendências foram ascendentes, com exceção de Pernambuco em que foi descendente, e estacionárias em Alagoas. Os homicídios por arma de fogo em via pública apresentaram maior percentual de aumento no período estudado. Observou-se tendência ascendente nos homicídios femininos perpetrados por arma de fogo na maioria dos estados nordestinos.

Abstract This article aims to analyze temporal trends in female firearm homicides in the Northeast of Brazil during the period 2000-2019. We conducted an ecological study using data on firearm homicides of women aged 10 years and over obtained from the Mortality Information System. The population data were taken from the 2010 Census. Homicide rates were calculated after correcting the data to account for differences in the quality and coverage of death records. Trends were assessed using negative binomial regression and described using relative risk and p values. Average annual percentage changes in homicide rates were also calculated. The regional firearm homicide rate during the study period was 4.40 per 100,000 women. Rates were highest in the state of Alagoas (5.40), the 15-19 age group (5.84) and in public thoroughfares (1.58). Trends were upward across all states except Pernambuco, where they were downward, and Alagoas, where rates were stationary. The place of occurrence with the highest percentage increase in firearm homicides over the study period was public thoroughfares. Female firearm homicides showed an upward trend across most northeastern states.

Efeito da idade-período-coorte na mortalidade por câncer do colo do útero no Centro-Oeste do Brasil, 1980-2019 / Age-period-cohort effect on cervical cancer mortality in the Center-West of Brazil, 1980-2019 / Efecto edad-período-cohorte en la mortalidad por cáncer de cuello uterino en el Centro-Oeste de Brasil, 1980-2019

Objetivos: analisar o efeito da idade-período-coorte nas taxas de mortalidade por câncer do colo do útero no Centro-Oeste do Brasil. Métodos: estudo ecológico de séries temporais, de 1980 a 2019, cujas fontes de dados foram o Sistema de Informação sobre Mortalidade e as estimativas populacionais do Instituto Brasileiro de Geografia e Estatística. Modelos de efeito idade-período-corte com distribuição de Poisson foram usados. Resultados: observaram-se 19.260 óbitos, correspondente à taxa de mortalidade padronizada média de 17,23/100 mil mulheres. O efeito da idade indicou aumento progressivo das taxas com o avançar da idade. O efeito do período evidenciou redução do risco de morte no Distrito Federal (2015-2019), Mato Grosso do Sul (2010-2014) e Mato Grosso (2010-2019), além de aumento em Goiás (2015-2019). O efeito da coorte revelou aumento do risco de morte para as nascidas antes de 1950-1954 e redução nas gerações a partir de 1955-1959. Conclusão: há evidências de efeito da idade-período-coorte na mortalidade por câncer do colo do útero no Centro-Oeste brasileiro, o que demanda fortalecimento de ações para sua prevenção e controle voltadas para mulheres de coortes e idades sob maior risco de morrer por essa causa.

Objectives: to analyze the effect of age-period-cohort on cervical cancer mortality rates in the Center-West of Brazil. Methods: ecological time series study from 1980 to 2019, utilizing data from the Mortality Information System and population estimates from the Brazilian Institute of Geography and Statistics. Age-period-cohort effect models with Poisson distribution were employed. Results: 19,260 deaths were observed, corresponding to an average standardized mortality rate of 17.23/100,000 women. The age effect indicated a progressive increase in rates as age advanced. The period effect showed a reduction in the risk of death in the Federal District (2015-2019), Mato Grosso do Sul (2010-2014), and Mato Grosso (2010-2019), as well as an increase in Goiás (2015-2019). The cohort effect showed an increase in the risk of death for those born before 1950-1954 and a reduction in the generations from 1955-1959 onwards. Conclusion: there is evidence of an age-period-cohort effect on mortality from cervical cancer in the Brazilian Center-West, which calls for the strengthening of actions for its prevention and control aimed at women of cohorts and ages at greater risk of dying from this cause.

Objetivos: análisis del efecto de la edad-período-cohorte en las tasas de mortalidad por cáncer de cuello uterino en el centro-oeste de Brasil. Métodos:estudio de series temporales ecológicas, de 1980 a 2019, cuyas fuentes de datos fueron el Sistema de Información de Mortalidad y las estimaciones de población del Instituto Brasileño de Geografía y Estadística. Se utilizaron modelos de efecto edad-período-corte con distribución de Poisson. Resultados: se registraron 19.260 fallecimientos, lo que corresponde a una tasa media de mortalidad estandarizada de 17,23/100.000 mujeres. El efecto edad indicó un aumento progresivo de las tasas con el avance de la edad. El efecto período mostró una reducción del riesgo de muerte en el Distrito Federal (2015-2019), Mato Grosso do Sul (2010-2014) y Mato Grosso (2010-2019), así como un aumento en Goiás (2015-2019). El efecto cohorte mostró un aumento del riesgo de muerte para los nacidos antes de 1950-1954 y una reducción en las generaciones a partir de 1955-1959. Conclusión: hay evidencias de un efecto edad-período-cohorte en la mortalidad por cáncer de cuello uterino en el Centro-Oeste brasileño, lo que exige el refuerzo de las acciones para su prevención y control dirigidas a las mujeres de cohortes y edades con mayor riesgo de morir por esta causa.

Anxiety and depression disorders in oncological patients under palliative care at a hospital service: a cross-sectional study.

BACKGROUND: This study aimed to evaluate the risk and protective factors associated with anxiety and depression symptoms in cancer patients at an advanced stage of cancer. METHODS: A cross-sectional study was conducted on patients with advanced cancer who were receiving palliative care. Cancer patients aged 18 years or older, with preserved cognitive function who completed the questionnaires were eligible. The questionnaires of Hospital Anxiety and Depression Scale (HADS) and health related of quality of life questionnaire; the European Organization for Research and Treatment of Cancer (EORTC-C30) were applied. Outcome variables were the depression and anxiety symptoms of cancer patients under palliative care, according to the answers to the 14 items that make up the HADS Scale. The analysis used the R software, version 4.2.0. RESULTS: Seventy cancer patients with advanced cancer were included. The colon was the most common neoplastic diagnostic (20%), followed by breast (12.9%) and lung (10%). The prevalence of depression was 44.3%, 25.7% anxiety and 52.9% had both symptoms. Patients with a high level of functionality had a lower chance of anxiety (OR = 0.80;p = 0.025), depression (OR = 0.82; p = 0.007), and anxiety and depression (OR = 0.82p = 0.008). We observed a lower chance of depression and depression/anxiety who showed a high level of Overall Performance. Three symptoms increased the chance of depression/anxiety: nausea/vomiting (p = 0.019), fatigue (0.031), loss of appetite (0.048). CONCLUSION: This study found high prevalence of anxiety and depression.Better quality of life and functionality were negatively associated with these outcomes. Examining the patient's functions will assist the clinician in alleviating symptoms of anxiety and depression, giving cancer patients in palliative care more dignity. TRIAL REGISTRATION: Not applicable.

Female Homicides in Brazil and Its Major Regions (1980-2019): An Analysis of Age, Period, and Cohort Effects.

The objective was to analyze the temporal effects of age, period, and cohort on mortality from all female homicides, and from female homicides and by firearms, in Brazil from 1980 to 2019. Data were accessed from Brazilian health records. There was an increase in the risk of death in the 2000s in the North and Northeast regions and a decrease in the Southeast, South, and Midwest. Younger women had a higher risk of death than women born between 1950 and 1954. The findings may be correlated with the inefficiency of the Brazilian state in protecting female victims of violence.

Factors associated with time-to-treatment initiation of breast cancer. / Fatores associados ao tempo para submissão ao primeiro tratamento do câncer de mama.

The present retrospective study investigated factors associated with time-to-treatment initiation of breast cancer of a cohort of 12,100 cases of health facilities qualified for high complexity in oncology within the scope of the Brazilian Public Health System (SUS) of Rio de Janeiro between 2013 and 2019. Multivariate logistic regression was used to estimate odds ratios and 95% confidence intervals. Of all cases, 82.1% were submitted to the first treatment >60 days. Patients without previous diagnosis history, higher education and in stages III and IV were less likely to have their first treatment >60 days, while treatment at a health facility outside the capital showed a higher probability. Patients with a previous diagnosis history, aged ≥50, non-white race/skin color and in stage I were more likely to be submitted to their first treatment >60 days, while subjects with higher education, treated in a health facility outside the capital and in stage IV showed a lower probability. To summarize, sociodemographic, clinical and health facility-related factors are associated with time-to-treatment initiation of breast cancer.

Este estudo retrospectivo investigou fatores associados ao tempo para submissão ao primeiro tratamento do câncer de mama entre 12.100 casos assistidos em estabelecimentos de saúde habilitados para a alta complexidade em oncologia no âmbito do SUS localizados no Rio de Janeiro entre 2013 e 2019. Regressão logística multivariada estimou razões de chances e intervalos de 95% de confiança. Foram submetidos ao primeiro tratamento em tempo >60 dias 82,1% dos casos. Entre aqueles sem histórico de diagnóstico anterior, alta escolaridade e estadiamento III e IV exibiram menor probabilidade de submissão ao primeiro tratamento em tempo >60 dias, enquanto tratamento em estabelecimento de saúde não localizado na capital exibiu probabilidade maior. Entre aqueles com histórico de diagnóstico anterior, idade ≥50 anos, raça/cor da pele não branca e estadiamento I exibiram maior probabilidade de submissão ao primeiro tratamento em tempo >60 dias, enquanto alta escolaridade, tratamento em estabelecimento de saúde não localizado na capital e estadiamento IV exibiram probabilidade menor. Em suma, fatores sociodemográficos, clínicos e relacionados ao estabelecimento de saúde estão associados ao tempo para submissão ao primeiro tratamento do câncer de mama.

Fatores associados ao tempo para submissão ao primeiro tratamento do câncer de mama / Factors associated with time-to-treatment initiation of breast cancer

Resumo Este estudo retrospectivo investigou fatores associados ao tempo para submissão ao primeiro tratamento do câncer de mama entre 12.100 casos assistidos em estabelecimentos de saúde habilitados para a alta complexidade em oncologia no âmbito do SUS localizados no Rio de Janeiro entre 2013 e 2019. Regressão logística multivariada estimou razões de chances e intervalos de 95% de confiança. Foram submetidos ao primeiro tratamento em tempo >60 dias 82,1% dos casos. Entre aqueles sem histórico de diagnóstico anterior, alta escolaridade e estadiamento III e IV exibiram menor probabilidade de submissão ao primeiro tratamento em tempo >60 dias, enquanto tratamento em estabelecimento de saúde não localizado na capital exibiu probabilidade maior. Entre aqueles com histórico de diagnóstico anterior, idade ≥50 anos, raça/cor da pele não branca e estadiamento I exibiram maior probabilidade de submissão ao primeiro tratamento em tempo >60 dias, enquanto alta escolaridade, tratamento em estabelecimento de saúde não localizado na capital e estadiamento IV exibiram probabilidade menor. Em suma, fatores sociodemográficos, clínicos e relacionados ao estabelecimento de saúde estão associados ao tempo para submissão ao primeiro tratamento do câncer de mama.

Abstract The present retrospective study investigated factors associated with time-to-treatment initiation of breast cancer of a cohort of 12,100 cases of health facilities qualified for high complexity in oncology within the scope of the Brazilian Public Health System (SUS) of Rio de Janeiro between 2013 and 2019. Multivariate logistic regression was used to estimate odds ratios and 95% confidence intervals. Of all cases, 82.1% were submitted to the first treatment >60 days. Patients without previous diagnosis history, higher education and in stages III and IV were less likely to have their first treatment >60 days, while treatment at a health facility outside the capital showed a higher probability. Patients with a previous diagnosis history, aged ≥50, non-white race/skin color and in stage I were more likely to be submitted to their first treatment >60 days, while subjects with higher education, treated in a health facility outside the capital and in stage IV showed a lower probability. To summarize, sociodemographic, clinical and health facility-related factors are associated with time-to-treatment initiation of breast cancer.

Suicide among women in Brazil: a necessary discussion from a gender perspective. / Suicídio de mulheres no Brasil: necessária discussão sob a perspectiva de gênero.

Suicide among women is a matter of public health, and there is a lack of scientific literature on this issue. In this theoretical essay, we sought to discuss suicide among women in Brazil from a gender perspective. For that purpose, we adopted the idea that gender extrapolates the concept of sex, considering that differences between people are produced by culture and arrangements through which society transforms biological sexuality into the realizations of human life. Therefore, this article is organized in a way to indicate some explanatory models of suicide among women, discussing gender inequalities and approaching the matter of intersectionality from a protective view. Moreover, we believe that the theme is extremely complex, considering that stigma still resists, as does prejudice related to this issue. Hence, it is of utmost importance to view the structural questions that refer to suicide in women, such as violence and gender inequalities.

O suicídio de mulheres constitui um problema de saúde pública e há escassez de literatura científica que discorra sobre a temática. Neste ensaio teórico, buscou-se discutir o suicídio de mulheres no Brasil, sob a perspectiva de gênero. Para isso, adotou-se a concepção que gênero extrapola o conceito de sexo, tendo em vista que as diferenças entre as pessoas são produzidas pela cultura e arranjos pelos quais uma sociedade transforma a sexualidade biológica em realizações da vida humana. Este texto foi organizado de modo a sinalizar alguns modelos explicativos do suicídio de mulheres, discutindo as desigualdades de gênero e abordando a questão da interseccionalidade a partir de uma visão protetiva. Ademais, acredita-se que o tema abordado é de extrema complexidade, tendo em vista que ainda resistem estigmas e preconceitos referente a este. Assim, urge visibilizar questões estruturais que cercam o suicídio em mulheres, como a violência e as desigualdades de gênero.

Suicídio de mulheres no Brasil: necessária discussão sob a perspectiva de gênero / Suicide among women in Brazil: a necessary discussion from a gender perspective

Resumo O suicídio de mulheres constitui um problema de saúde pública e há escassez de literatura científica que discorra sobre a temática. Neste ensaio teórico, buscou-se discutir o suicídio de mulheres no Brasil, sob a perspectiva de gênero. Para isso, adotou-se a concepção que gênero extrapola o conceito de sexo, tendo em vista que as diferenças entre as pessoas são produzidas pela cultura e arranjos pelos quais uma sociedade transforma a sexualidade biológica em realizações da vida humana. Este texto foi organizado de modo a sinalizar alguns modelos explicativos do suicídio de mulheres, discutindo as desigualdades de gênero e abordando a questão da interseccionalidade a partir de uma visão protetiva. Ademais, acredita-se que o tema abordado é de extrema complexidade, tendo em vista que ainda resistem estigmas e preconceitos referente a este. Assim, urge visibilizar questões estruturais que cercam o suicídio em mulheres, como a violência e as desigualdades de gênero.

Abstract Suicide among women is a matter of public health, and there is a lack of scientific literature on this issue. In this theoretical essay, we sought to discuss suicide among women in Brazil from a gender perspective. For that purpose, we adopted the idea that gender extrapolates the concept of sex, considering that differences between people are produced by culture and arrangements through which society transforms biological sexuality into the realizations of human life. Therefore, this article is organized in a way to indicate some explanatory models of suicide among women, discussing gender inequalities and approaching the matter of intersectionality from a protective view. Moreover, we believe that the theme is extremely complex, considering that stigma still resists, as does prejudice related to this issue. Hence, it is of utmost importance to view the structural questions that refer to suicide in women, such as violence and gender inequalities.

The influence of the age-period-cohort effects on male suicide in Brazil from 1980 to 2019.

Suicide is a complex and multi-determined phenomenon. Higher rates are observed in men and are related to multiple risk factors, including mental disorders, financial crises, unemployment, and easy access to highly lethal means of perpetration, such as firearms. We studied the effects of age, period, and cohort (APC) on total and firearm-related suicides in men in Brazil and its major regions from 1980 to 2019. Death records were extracted from the Brazilian Ministry of Health's Mortality Information System. Estimable functions were used to estimate APC models, through the Epi library of the R statistical program, version 4.2.1. During the study period, Brazil had an average rate of 10.22 deaths per 100,000 men. Among regions, rates ranged from 8.62 (Northeast) to 16.93 (South). The same profile was observed in suicides by firearms. After estimating the APC models, we observed a temporal trend of increasing total suicides for Brazil and regions, except for the South region, where the trend was stationary. The trend was downward for firearm suicides for all locations. A positive gradient was observed in the mortality rate with advancing age for total suicides; and peak incidence between 20-29 years, with subsequent stabilization, for suicides perpetrated by firearms. There was a reduction in the risk of death for suicides perpetrated by firearms in relation to the reference period (1995-1999) for all locations, except in the North region, where the effect was not significant. The younger generations from the 1960s onwards had a higher risk of death from total suicide and a lower risk for those perpetrated by firearms in relation to the reference cohort (1950-1954). We observed a reduction in the mortality trend for suicides perpetrated by firearms, a reduction in the risk of death in the 2000s and for men born after 1960. Our results suggest reducing the risk of death from suicide by firearms in Brazil and regions. However, there is an upward trend in mortality from total suicides in the study period (1980-2019) and for younger cohorts.