Long COVID symptoms and sleep problems: a population-based study.

To investigate the association between symptoms of long-term effects of coronavirus disease 2019 (long COVID) and sleep problems in a sample population from southern Brazil. This cross-sectional study used data from the SULcovid-19 survey, developed in the municipality of Rio Grande, RS, Brazil. The outcome, long COVID, was investigated through the presence of 18 symptoms, and the exposure variable was sleep problems. Poisson regression with robust adjustment for variance was used to estimate crude and adjusted prevalence ratios for the outcome-exposure relationship. Odds ratio was calculated through multinomial regression of the relationship between the number of symptoms of long COVID and sleep problems. Analyses were adjusted for sex, age, marital status, income, body mass index, smoking status, comorbidities, and hospital admission. A total of 2919 adults and older adults were interviewed. The prevalence of long COVID was 48.3% (95% confidence interval [CI] 46.5-50.1%) and sleep problems were reported by 41.2% of the sample (95% CI 39.4-43.0%). Individuals with sleep problems were more likely to exhibit altered sensitivity (prevalence ratio [PR] 3.27; 95% CI 1.96-5.45), nasal congestion (PR 2.75; 95% CI 1.53-4.94), musculoskeletal symptoms (PR 1.75; 95% CI 1.48-2.06), respiratory issues (PR 1.58; 95% CI 1.24-2.01), and one or more symptom of long COVID (PR 1.27; 95% CI 1.15-1.39). Approximately one-half of the population analysed had long COVID, and four of 10 reported experiencing sleep problems. In addition, the sample tended to have experienced a greater number of symptoms compared with those who reported to sleep well.

[Complications due to diabetes mellitus in Brazil: 2019 nationwide study]. / Complicações por diabetes mellitus no Brasil: estudo de base nacional, 2019.

Inadequate management of diabetes mellitus (DM) can lead to complications that affect quality of life. The prevalence of DM and its complications is increasing, presenting an uneven distribution in the population. The objective was to estimate the prevalence of complications due to DM and to assess inequalities in the Brazilian population. It involved a cross-sectional study, with data from the 2019 National Health Survey (NHS). The complications evaluated were: diabetic coma, heart attack/cerebrovascular accident/stroke; kidney problem; vision problem and foot ulcer or amputation. The related factors were schooling and income. The prevalence of complications was calculated separately, combination in pairs, presence of any complications and number of complications. Inequality was estimated through adjusted analysis and the slope index (SII) and concentration index (CIX) indices. The sample consisted of 6,317 people with DM. More than a third (37.8%) reported having some complication. Vision problems (30.6%) and kidney problems (9.7%) were the most prevalent. The prevalence of having "one" and "two or more" complications were 25.4% and 12.4%, respectively. Inequalities were found with a higher prevalence of complications among the least educated and the poorest.

O manejo inadequado da diabetes mellitus (DM) pode levar a complicações que afetam a qualidade de vida. A prevalência da DM e suas complicações está aumentando, apresentando distribuição desigual na população. O objetivo foi estimar a prevalência de complicações devido à DM e avaliar as desigualdades na população brasileira. Estudo transversal, com dados da Pesquisa Nacional de Saúde (PNS), de 2019. As complicações avaliadas foram: coma diabético, infarto/Acidente Vascular Cerebral/derrame, problema nos rins, problema na visão e úlcera nos pés ou amputação. As exposições foram a escolaridade e renda. Foram calculadas as prevalências das complicações separadamente, combinação em duplas, presença de alguma complicação e número de complicações. A desigualdade foi estimada por meio de análise ajustada e dos índices: slope index (SII) e o concentration index (CIX). A amostra foi composta por 6.317 pessoas com DM. Mais de um terço (37,8%) referiu ter alguma complicação. O problema na visão (30,6%) e nos rins (9,7%) foram os mais prevalentes. As prevalências de ter "uma" e "duas ou mais" complicações foram 25,4% e 12,4%. Foram evidenciadas desigualdades com maior prevalência de complicações entre os menos escolarizados e mais pobres.

Complicações por diabetes mellitus no Brasil: estudo de base nacional, 2019 / Complications due to diabetes mellitus in Brazil: 2019 nationwide study

Resumo O manejo inadequado da diabetes mellitus (DM) pode levar a complicações que afetam a qualidade de vida. A prevalência da DM e suas complicações está aumentando, apresentando distribuição desigual na população. O objetivo foi estimar a prevalência de complicações devido à DM e avaliar as desigualdades na população brasileira. Estudo transversal, com dados da Pesquisa Nacional de Saúde (PNS), de 2019. As complicações avaliadas foram: coma diabético, infarto/Acidente Vascular Cerebral/derrame, problema nos rins, problema na visão e úlcera nos pés ou amputação. As exposições foram a escolaridade e renda. Foram calculadas as prevalências das complicações separadamente, combinação em duplas, presença de alguma complicação e número de complicações. A desigualdade foi estimada por meio de análise ajustada e dos índices: slope index (SII) e o concentration index (CIX). A amostra foi composta por 6.317 pessoas com DM. Mais de um terço (37,8%) referiu ter alguma complicação. O problema na visão (30,6%) e nos rins (9,7%) foram os mais prevalentes. As prevalências de ter "uma" e "duas ou mais" complicações foram 25,4% e 12,4%. Foram evidenciadas desigualdades com maior prevalência de complicações entre os menos escolarizados e mais pobres.

Abstract Inadequate management of diabetes mellitus (DM) can lead to complications that affect quality of life. The prevalence of DM and its complications is increasing, presenting an uneven distribution in the population. The objective was to estimate the prevalence of complications due to DM and to assess inequalities in the Brazilian population. It involved a cross-sectional study, with data from the 2019 National Health Survey (NHS). The complications evaluated were: diabetic coma, heart attack/cerebrovascular accident/stroke; kidney problem; vision problem and foot ulcer or amputation. The related factors were schooling and income. The prevalence of complications was calculated separately, combination in pairs, presence of any complications and number of complications. Inequality was estimated through adjusted analysis and the slope index (SII) and concentration index (CIX) indices. The sample consisted of 6,317 people with DM. More than a third (37.8%) reported having some complication. Vision problems (30.6%) and kidney problems (9.7%) were the most prevalent. The prevalence of having "one" and "two or more" complications were 25.4% and 12.4%, respectively. Inequalities were found with a higher prevalence of complications among the least educated and the poorest.

Musculoskeletal pain during and after SARS-CoV-2 infection and healthcare utilization: a cross-sectional study.

BACKGROUND: The COVID-19 pandemic necessitated the reorganization of health services to cater to the needs of individuals affected by the virus. OBJECTIVE: This study aimed to examine the association between musculoskeletal pain during and after SARS-CoV-2 infection and the utilization of health services among adults in southern Brazil.  METHODS: A cross-sectional study was conducted with individuals aged 18 years and older, who were diagnosed with COVID-19 between December 2020 and March 2021. Questionnaires were electronically collected using tablets through the REDCap platform via phone calls. The health service utilization outcomes assessed included Primary Health Care, general practitioners, private emergency care, and specialized services. The exposure variable was the presence of musculoskeletal pain during and after SARS-CoV-2 infection in different regions, such as cervical, upper limbs, thoracic, lumbar, and lower limbs. Poisson regression analysis was employed to assess the relationship between health service utilization during and after SARS-CoV-2 infection and musculoskeletal pain during and after the infection with SARS-CoV-2 among adults in southern Brazil. Data were analyzed using the Stata 16.1 statistical package.  RESULTS: A total of 2,919 individuals were interviewed. Overall, individuals with musculoskeletal pain were found to utilize health services approximately 15 percentage points higher when compared to those without musculoskeletal pain. In adjusted analysis, individuals who reported musculoskeletal pain during and after SARS-CoV-2 infection were up to twice as likely to use health services. Among them, the emergency care unit was the most frequently used service, particularly in those with pain in the lower limbs (RP=2.19, 95% CI 1.66-2.87) and thoracic region (RP=2.04, 95% CI 1.47-2.84). Notably, the highest magnitudes of association were observed with emergency care units, specialist doctors, and specialized services, especially neurologists, who were two to three times more likely to be sought, followed by pulmonologists.  CONCLUSION: Health service utilization was significantly associated with musculoskeletal pain during and after SARS-CoV-2 infection. All regions, except for the cervical region, showed a correlation with the use of Primary Health Care. The thoracic region featured an association with pulmonologists and emergency room utilization. Additionally, health services like emergency care units, specialist doctors, and specialized services, including cardiologists and neurologists, were commonly utilized across all regions in southern Brazil.

Inequalities in access to integrative and complementary health practices in Brazil: National Health Survey, 2019.

Aim: Integrative and complementary practices (PICs) can be important health care strategies, mainly because they consider the integrality of the person. The objective of this article was to verify the inequality in the access to PICs of the Brazilian population based on data from the National Health Survey (PNS). Subject and methods: This is a population-based cross-sectional study, with data from the 2019 PNS. The use of PICs in the past 12 months was investigated. Adjusted analysis was performed using Poisson regression and the Slope Index of Inequality (SII) and the Concentration Index (CIX) were used to assess absolute and relative inequality. Results: The prevalence of PIC use in Brazil was 5.4% (95%CI 5.3; 5.5). Individuals from the richest quintile, with higher education and with health insurance were more likely to use PICs in general, except for medicinal plants/herbal medicine. When observing the magnitude of inequalities, this was more positively accentuated in those with higher education and who had a private health plan. Conclusion: The results reveal social inequalities in the access to integrative practices, where the most elitist are more accessed by people with better socioeconomic conditions.

Time evolution of advice on healthy habits in Brazilians with hypertension and diabetes: National Health Survey / Evolução temporal de orientações sobre hábitos saudáveis em brasileiros com hipertensão e diabetes: Pesquisa Nacional de Saúde

Abstract To evaluate time evolution of receiving advice on healthy habits among Brazilians with hypertension and diabetes mellitus. Cross-sectional study with data from the 2013 and 2019 National Health Survey. We used linear regression weighted by least squares of variance to verify time evolution of the outcome estimating the annual percentage change (APC) presented according to sex, skin color, age group, and quintiles of wealth index. The analytical sample in 2013 was 11,129 individuals with hypertension and 3,182 individuals with diabetes, and in 2019 19,107 individuals with hypertension and 6,317 individuals with diabetes. For those with hypertension, there were statistically significant reductions in receiving advice for not smoking (APC: -1.49), not drinking excessive alcoholic beverages (APC: -1.48), ingesting less salt (APC: -0.56), and for all healthy habits (APC: -1.17). For those with diabetes, statistically significant reductions were observed only for not smoking (APC: -1.13) and not drinking excessive alcoholic beverages (APC: -1.11). The results suggest a reduction in all types of advice on healthy habits evaluated for hypertension and diabetes, with greater magnitude among individuals belonging to the richest quintiles.

Resumo O objetivo foi avaliar a evolução temporal do recebimento de orientações sobre hábitos saudáveis entre brasileiros com hipertensão arterial e diabetes mellitus. Estudo transversal com dados da Pesquisa Nacional de Saúde de 2013 e 2019. Para verificar a evolução temporal das prevalências de orientações sobre hábitos saudáveis, realizadas por profissionais de saúde nos atendimentos para as morbidades, utilizou-se regressão linear ponderada pelos quadrados mínimos da variância, estimando a variação percentual anual (VPA) apresentada de acordo com sexo, cor da pele, faixa etária e quintis do índice de bens. A amostra analítica, em 2013, foi de 11.129 indivíduos com hipertensão e 3.182 com diabetes, e em 2019, de 19.107 indivíduos com hipertensão e 6.317 com diabetes. Para hipertensão, observou-se reduções nas orientações para não fumar (VPA: -1.49), não ingerir bebidas alcoólicas em excesso (VPA: -1.48), ingerir menos sal (VPA: -0.56) e, ainda, para todas as orientações (VPA: -1.17). Para diabetes, foram observadas reduções estatisticamente significativas apenas para não fumantes (APC: -1.13) e para os que não consomem bebidas alcoólicas em excesso (APC: -1.11). Os resultados sugerem redução de todas as orientações avaliadas para hipertensão e diabetes, com maior magnitude entre os indivíduos pertencentes aos quintis mais ricos.

Inequalities in the management of back pain care in Brazil - National Health Survey, 2019 / Desigualdades no manejo da dor nas costas no Brasil - Pesquisa Nacional de Saúde, 2019

Abstract The aim was to assess the presence of socioeconomic inequalities in the management of back pain among Brazilians. Cross-sectional study with data from the National Health Survey (2019). The management of back pain care was assessed using five outcomes: regular exercise; physiotherapy; use of medications or injections; integrative and complementary practice; regular follow-up with a health professional. The magnitude of inequalities of each outcome in relation to exposures (education and income) was estimated using two indices: slope index of inequality (SII) and concentration index (CIX). Of the 90,846 interviewees, 19,206 individuals (21.1%) reported some chronic back problem. The most prevalent outcomes were use of medications and injections (45.3%), physical exercise (26.3%) and regular follow-up with a health professional (24.7%). The existence of inequalities in the management of back pain in the Brazilian population was evident. The adjusted analysis showed that the richest and most educated performed two to three times more physical exercise, physiotherapy, integrative and complementary practices (ICPS) and regular follow-up with a health professional than the poorest and least educated. Absolute (SII) and relative (CIX) inequalities were significant for all outcomes.

Resumo O objetivo foi avaliar a presença de desigualdades socioeconômicas no manejo da dor nas costas em brasileiros. Estudo transversal com dados da Pesquisa Nacional de Saúde (2019). O manejo da dor nas costas foi avaliado por meio de cinco desfechos: exercícios regulares; fisioterapia; uso de medicamentos ou injeções; prática integrativa e complementar; acompanhamento regular com profissional de saúde. A magnitude das desigualdades de cada desfecho em relação às exposições (escolaridade e renda) foi estimada por meio de dois índices: slope index of inequality (SII) e concentration index (CIX). Dos 90.846 entrevistados, 19.206 indivíduos (21,1%) relataram algum problema crônico nas costas. Os desfechos mais prevalentes foram uso de medicamentos e injeções (45,3%), prática de exercícios físicos (26,3%) e acompanhamento regular com profissional de saúde (24,7%). Ficou evidente a existência de desigualdades no manejo da dor nas costas entre brasileiros. Análise ajustada mostrou que os mais ricos e com maior escolaridade realizavam duas a três vezes mais exercícios físicos, fisioterapia, práticas integrativas e complementares (ICPS) e acompanhamento regular com profissional de saúde do que os mais pobres e com menor escolaridade. Desigualdades absolutas (SII) e relativas (CIX) foram significativas para todos os desfechos.

Inequalities in the management of back pain care in Brazil - National Health Survey, 2019.

The aim was to assess the presence of socioeconomic inequalities in the management of back pain among Brazilians. Cross-sectional study with data from the National Health Survey (2019). The management of back pain care was assessed using five outcomes: regular exercise; physiotherapy; use of medications or injections; integrative and complementary practice; regular follow-up with a health professional. The magnitude of inequalities of each outcome in relation to exposures (education and income) was estimated using two indices: slope index of inequality (SII) and concentration index (CIX). Of the 90,846 interviewees, 19,206 individuals (21.1%) reported some chronic back problem. The most prevalent outcomes were use of medications and injections (45.3%), physical exercise (26.3%) and regular follow-up with a health professional (24.7%). The existence of inequalities in the management of back pain in the Brazilian population was evident. The adjusted analysis showed that the richest and most educated performed two to three times more physical exercise, physiotherapy, integrative and complementary practices (ICPS) and regular follow-up with a health professional than the poorest and least educated. Absolute (SII) and relative (CIX) inequalities were significant for all outcomes.

Time evolution of advice on healthy habits in Brazilians with hypertension and diabetes: National Health Survey.

To evaluate time evolution of receiving advice on healthy habits among Brazilians with hypertension and diabetes mellitus. Cross-sectional study with data from the 2013 and 2019 National Health Survey. We used linear regression weighted by least squares of variance to verify time evolution of the outcome estimating the annual percentage change (APC) presented according to sex, skin color, age group, and quintiles of wealth index. The analytical sample in 2013 was 11,129 individuals with hypertension and 3,182 individuals with diabetes, and in 2019 19,107 individuals with hypertension and 6,317 individuals with diabetes. For those with hypertension, there were statistically significant reductions in receiving advice for not smoking (APC: -1.49), not drinking excessive alcoholic beverages (APC: -1.48), ingesting less salt (APC: -0.56), and for all healthy habits (APC: -1.17). For those with diabetes, statistically significant reductions were observed only for not smoking (APC: -1.13) and not drinking excessive alcoholic beverages (APC: -1.11). The results suggest a reduction in all types of advice on healthy habits evaluated for hypertension and diabetes, with greater magnitude among individuals belonging to the richest quintiles.

[Trends and inequalities in self-reported cervical cancer screening in Brazilian capitals from 2011 to 2020]. / Tendência e desigualdades no rastreamento autorrelatado do câncer de colo de útero nas capitais brasileiras entre 2011 e 2020.

This study aimed to verify the temporal trend and inequalities in self-reported cervical cancer screening in Brazilian capitals from 2011 to 2020. This is a trend study with Risk and Protective Factors Surveillance System for Chronic Non-Communicable Diseases Through Telephone Interview (Vigitel) data from 2011 to 2020. The outcome was the prevalence of cytopathological examination in the last three years. Slope index of inequality (SII) and concentration index (CIX) were used to estimate inequalities. An increasing trend in the outcome was observed in Brazil in the period surveyed, as well as a decrease in most regions, capitals, and in all groups according to education. There was a decrease in coverage in most regions of Brazil. We highlight that SII presented its worst results in 2011 and 2012, reaching 15.8p.p. (95%CI: 14.1; 17.6) and 15.0p.p. (95%CI: 13.1; 16.9), respectively, among women with 12 years or more of education. There was a decrease in coverage of cervical cancer screening in most Brazilian regions and capitals from 2011 to 2020. In the period before and during the pandemic, a reduction in the outcome was observed in the South and Southeast regions, suggesting that the COVID-19 pandemic caused geographical inequalities in the coverage for this exam in Brazil.

Este estudo teve como objetivo verificar a tendência temporal e desigualdades no rastreamento autorrelatado do câncer de colo de útero nas capitais brasileiras entre os anos de 2011 e 2020. Estudo de tendência com dados da Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel) de 2011 a 2020. O desfecho foi a prevalência de realização de exame citopatológico nos últimos três anos. Para estimar as desigualdades, foram utilizados os índices de desigualdade de inclinação (slope index of inequality - SII) e de concentração (concentration index - CIX). Observou-se tendência crescente do desfecho no país no período pesquisado e queda na maioria das regiões, capitais e em todos os grupos de acordo com escolaridade. Houve uma queda da cobertura na maioria das regiões do Brasil. Destaca-se que o SII apresentou seus piores resultados em 2011 e 2012, alcançando 15,8p.p. (IC95%: 14,1; 17,6) e 15,0p.p. (IC95%: 13,1; 16,9), respectivamente, entre as mulheres com 12 anos ou mais de estudo. Houve queda na cobertura da realização do exame preventivo de câncer de colo de útero na maioria das regiões e capitais brasileiras entre os anos de 2011 e 2020. No período antes e durante a pandemia, houve redução do desfecho no país, nas regiões Sul e Sudeste, sugerindo que a pandemia de COVID-19 acarretou desigualdades geográficas na cobertura desse exame no país.

Este estudio tuvo como objetivo verificar la tendencia temporal y las desigualdades en el seguimiento autoinformado de cáncer de cuello uterino en las capitales brasileñas entre 2011 y 2020. Estudio de tendencias con datos de Vigilancia de Factores de Riesgo y Protección de Enfermedades Crónicas por Encuesta Telefónica (Vigitel) en el período de 2011 a 2020. El desenlace fue la prevalencia del examen citopatológico en los últimos tres años. Para estimar las desigualdades se utilizaron los índices de inequidad absoluto (slope index of inequality - SII) y de concentración (concentration index - CIX). Hubo tendencia a un aumento del desenlace en el período en estudio y un descenso en la mayoría de las regiones, capitales y en todos los grupos según el nivel educativo. Se observó un descenso en la cobertura en la mayoría de las regiones de Brasil. Se destaca que el SII presentó un peor resultado en 2011 y 2012, alcanzando 15,8p.p. (IC95%: 14,1; 17,6) y 15,0p.p. (IC95%: 13,1; 16,9), respectivamente, entre mujeres con 12 años o más de escolaridad. Hubo un descenso en la cobertura de la detección de cáncer de cuello uterino en la mayoría de las regiones y capitales brasileñas entre 2011 y 2020. En el período anterior y durante la pandemia, hubo una reducción en el desenlace para el país, en las regiones Sur y Sudeste, lo que apunta que la pandemia del COVID-19 provocó desigualdades geográficas en la cobertura de este examen a nivel nacional.

Adequacy of care for people with arterial hypertension in Brazil: National Health Survey, 2013 and 2019. / Adequação do cuidado a pessoas com hipertensão arterial no Brasil: Pesquisa Nacional de Saúde, 2013 e 2019.

OBJECTIVE: To analyze adequacy of care received by adults and elderly people with arterial hypertension, and its association with region of the country, demographic, socioeconomic and health system characteristics in Brazil in 2013 and 2019. METHODS: This was a cross-sectional study using National Health Survey data. People aged ≥18 years with diagnosis of hypertension and medical consultation for this reason in the last three years were included. Adequacy of care was analyzed based on 11 indicators and using Poisson regression. RESULTS: Adequate care was provided to 11,129 people with hypertension (25.3%; 95%CI 24.5;26.1) in 2013 and to 19,107 (18.8%; 95%CI 18.2;19.3) in 2019. Adequate care prevalence was 2.54 (95%CI 2.03;3.17) times higher in 2013, and 3.53 (95%CI 2.94;4.23) times higher in 2019 among individuals belonging to the highest socioeconomic quintile compared to those belonging to the poorest. CONCLUSION: We identified that care decreased, and economic inequalities intensified in the period 2013-2019.

Inequalities in care for the people with diabetes in Brazil: A nationwide study, 2019.

The purpose of this paper is to evaluate inequalities in care for people with diabetes in Brazil. This cross-sectional population-based study was carried out in 2019 and evaluated care provided by receiving advice, requesting laboratory tests, and performing examinations. We used the slope index of inequality and concentration index to assess inequalities according to educational level and Poisson regression to estimate prevalence ratios for each outcome in the education category. We assessed a total of 6317 people with diabetes, 41.8% had their eyes checked, and 36.1% had their feet examined in the previous year. Prevalence for both examinations was 2.45 times higher in those from the highest level of education compared to those from the lowest level. The largest absolute differences (in percentage points) between the lowest and highest education levels in care indicators were the following: request for glycated hemoglobin test (39.0), glucose curve test (31.4), and eyes checked in the previous year (29.7). There were notable inequalities in the prevalence ratios of care provided to people with diabetes in Brazil. Requests for glycated hemoglobin tests, glucose curve tests, eye and feet examinations should be emphasized, especially for people from lower educational levels.

[Socioeconomic inequalities in the food consumption of the elderly Brazilian population: National Health Survey, 2019]. / Desigualdades socioeconômicas no consumo alimentar da população idosa brasileira: Pesquisa Nacional de Saúde, 2019.

Food consumption, when performed in an unhealthy manner, has consequences for the health of individuals, such as a higher incidence of excess weight and the exacerbation of pre-existing chronic diseases. The scope of this article was to assess summary inequalities in food consumption among the elderly population in Brazil. It involved a cross-sectional study, with data from the 2019 National Health Survey. The following outcomes were evaluated: consumption of beans, greens/vegetables, fruit, milk, meat, soda, candies and salt. The main exposure variable was education. An adjusted analysis was conducted and two indices were also used to measure inequality: the slope index (SII) and the concentration index (CIX). A total of 43,554 elderly people were investigated. It was identified that the more educated were 80% more likely to consume vegetables, fruit and milk, while the consumption of beans and meat was up to 50% lower among the less educated. The analyses of relative and absolute inequality reinforce the lower consumption of foods considered healthy among the less educated elderly individuals. The results reveal inequalities in food consumption among the elderly, with greater magnitude in food recognized as being healthy.

O consumo alimentar, quando realizado de forma não saudável, traz consequências para a saúde dos indivíduos, como uma maior ocorrência de excesso de peso e o agravamento de doenças crônicas prévias. O objetivo deste artigo foi avaliar as desigualdades sumárias no consumo alimentar da população idosa no Brasil. Trata-se de um estudo transversal, com dados da Pesquisa Nacional de Saúde de 2019. Foram avaliados os seguintes desfechos: consumo de feijão, verduras/legumes, frutas, leite, carnes, refrigerante, doces e sal. A principal variável de exposição foi escolaridade. Para mensuração da desigualdade foi realizada análise ajustada e também foram utilizados dois índices: slope index (SII) e o concentration index (CIX). Foram investigados 43.554 idosos. Identificou-se que os mais escolarizados tinham até 80,0% mais probabilidade de consumir verduras, frutas e leite, enquanto o consumo de feijão e de carnes foi até 50,0% menor nos mais escolarizados. As análises de desigualdade relativa e absoluta reforçam o menor consumo de alimentos considerados saudáveis entre os idosos menos escolarizados. Os resultados revelam iniquidades no consumo alimentar entre idosos, com maior magnitude nos alimentos reconhecidamente saudáveis.

[Trend in the availability of vaccines in Brazil: PMAQ-AB, 2012, 2014, and 2018]. / Tendência da disponibilidade de vacinas no Brasil: PMAQ-AB 2012, 2014 e 2018.

The objective was to analyze the trend in the availability of vaccines in Brazil and its various regions and states from 2012 to 2018. This cross-sectional study used data from basic units assessed in cycles I (2012), II (2014), and III (2018) of the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB). We assessed the availability of the dT, hepatitis B, meningococcal C, polio, pneumococcal 10-valent, MMR, DPT, tetravalent/pentavalent, and human rotavirus vaccines. Identification of trend was performed with weighted least squares regression to estimate annual percent changes. We also verified the relative and absolute differences in prevalence of vaccines. The sample consisted of 13,842 basic health units in Cycle I, 19,752 in Cycle II, and 25,152 in Cycle III. An upward trend was seen in the prevalence of availability of all vaccines investigated during the period, with an increase of 16 percentage points from 2012 to 2018, reaching nearly 70% in 2018. The regions with the largest upward trend were the North (2.9p.p.), Central-West (2.1p.p.), and Northeast (2.0p.p.). There was a visible downward trend in both the availability (-3.3p.p.) and absolute and relative difference (-20p.p.; 0.68) in Rio de Janeiro State. The prevalence of availability of vaccines was low in Brazil, with disparities between regions that become even more pronounced when assessing specific states.

O objetivo foi analisar a tendência da disponibilidade de vacinas no Brasil, em suas regiões e Unidades da Federação (UFs), de 2012 a 2018. Estudo transversal realizado com dados das unidades básicas avaliadas nos ciclos I (2012), II (2014) e III (2018) do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). Foi avaliada a disponibilidade das vacinas dupla dT, hepatite B, meningocócica C, poliomielite, pneumocócica 10, tríplice viral, tríplice bacteriana, tetravalente/pentavalente e rotavírus humano. Para identificação da tendência, foi realizada regressão de mínimos quadrados ponderada por variância para estimar mudanças anuais, em pontos percentuais. Também foi verificada a diferença relativa e absoluta da prevalência de vacinas. A amostra foi composta por 13.842 unidades básicas de saúde (UBS) no Ciclo I, 19.752 no Ciclo II e 25.152 no Ciclo III. Verificou-se tendência crescente da prevalência de disponibilidade de todas as vacinas investigadas no período avaliado, com aumento de 16p.p. entre 2012 e 2018, alcançando cerca de 70% em 2018. As regiões com maior tendência de aumento foram o Norte (2,9p.p.), Centro-oeste (2,1p.p.) e Nordeste (2,0p.p.). Destaque-se a tendência decrescente na disponibilidade (-3,3p.p.) e, também, nas diferenças absoluta e relativa negativas (-20p.p.; 0,68) verificadas no Rio de Janeiro. Identificou-se prevalência de disponibilidade de vacina baixa no Brasil, com disparidades entre as regiões, que ficam mais marcantes na avaliação das UFs.

El objetivo fue analizar la tendencia de la disponibilidad de vacunas en Brasil, en sus regiones y Unidades de la Federación (UFs), de 2012 a 2018. Estudio transversal realizado con datos de las unidades básicas, evaluadas en los ciclos I (2012), II (2014) y III (2018) del Programa Nacional de Mejoría de Acceso y Calidad de la Atención Básica (PMAQ-AB). Se evaluó la disponibilidad de las vacunas doble dT, hepatitis B, meningocócica C, poliomielitis, neumocócica 10, triple viral, triple bacteriana, tetravalente/pentavalente y rotavirus humano. Para la identificación de la tendencia se realizó una regresión de mínimos cuadrados ponderada por variancia para estimar cambios anuales, en puntos porcentuales. También se verificó la diferencia relativa y absoluta de la prevalencia de vacunas. La muestra estuvo compuesta por 13.842 unidades basicas de salud en el Ciclo I, 19.752 en el Ciclo II y 25.152 en el Ciclo III. Se verificó la tendencia creciente de la prevalencia de disponibilidad de todas las vacunas investigadas en el período evaluado, con un aumento de 16p.p entre 2012 y 2018, alcanzando cerca de un 70% en 2018. Las regiones con mayor tendencia de aumento fueron el Norte (2,9p.p.), Centro-oeste (2,1p.p.) y Nordeste (2,0p.p.). Se destaca la tendencia decreciente en la disponibilidad (-3,3p.p.) y también en la diferencia absoluta y relativa negativas (-20p.p.; 0,68), verificadas en Río de Janeiro. Se identificó la prevalencia de una disponibilidad baja de vacunación en Brasil, con disparidades entre las regiones, que son más visibles en la evaluación de las UFs.

Evolution of the quality of prenatal care in the primary network of Brazil from 2012 to 2018: What can (and should) improve?

The article describes the temporal evolution of prenatal quality indicators in the primary health care network in Brazil and investigates regional differences. This study used data from the external evaluation of Brazil's National Program for Improving Primary Care Access and Quality (PMAQ) with health teams participating in Cycles I, II and III of the Program, carried out respectively in 2012, 2013/14 and 2017/18. The number of visits, physical examination procedures, guidelines and request for laboratory tests were investigated. There was a positive evolution for tests-HIV, syphilis, blood glucose and ultrasound, and for all tests, guidance on feeding and weight gain of the baby and examination of the oral cavity. The indicators that performed the worst were: performance of tetanus vaccine, six or more visits, receiving guidance on exclusive breastfeeding and care for the newborn, and the procedures-all, measurement of uterine height, gynecological exam and cervix cancer prevention. These changes had a varied behavior between the regions of the country.

Tendência e desigualdades no rastreamento autorrelatado do câncer de colo de útero nas capitais brasileiras entre 2011 e 2020 / Trends and inequalities in self-reported cervical cancer screening in Brazilian capitals from 2011 to 2020 / Tendencias y desigualdades en el seguimiento autoinformado de cáncer de cuello uterino en las capitales brasileñas entre 2011 y 2020

Resumo: Este estudo teve como objetivo verificar a tendência temporal e desigualdades no rastreamento autorrelatado do câncer de colo de útero nas capitais brasileiras entre os anos de 2011 e 2020. Estudo de tendência com dados da Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel) de 2011 a 2020. O desfecho foi a prevalência de realização de exame citopatológico nos últimos três anos. Para estimar as desigualdades, foram utilizados os índices de desigualdade de inclinação (slope index of inequality - SII) e de concentração (concentration index - CIX). Observou-se tendência crescente do desfecho no país no período pesquisado e queda na maioria das regiões, capitais e em todos os grupos de acordo com escolaridade. Houve uma queda da cobertura na maioria das regiões do Brasil. Destaca-se que o SII apresentou seus piores resultados em 2011 e 2012, alcançando 15,8p.p. (IC95%: 14,1; 17,6) e 15,0p.p. (IC95%: 13,1; 16,9), respectivamente, entre as mulheres com 12 anos ou mais de estudo. Houve queda na cobertura da realização do exame preventivo de câncer de colo de útero na maioria das regiões e capitais brasileiras entre os anos de 2011 e 2020. No período antes e durante a pandemia, houve redução do desfecho no país, nas regiões Sul e Sudeste, sugerindo que a pandemia de COVID-19 acarretou desigualdades geográficas na cobertura desse exame no país.

Abstract: This study aimed to verify the temporal trend and inequalities in self-reported cervical cancer screening in Brazilian capitals from 2011 to 2020. This is a trend study with Risk and Protective Factors Surveillance System for Chronic Non-Communicable Diseases Through Telephone Interview (Vigitel) data from 2011 to 2020. The outcome was the prevalence of cytopathological examination in the last three years. Slope index of inequality (SII) and concentration index (CIX) were used to estimate inequalities. An increasing trend in the outcome was observed in Brazil in the period surveyed, as well as a decrease in most regions, capitals, and in all groups according to education. There was a decrease in coverage in most regions of Brazil. We highlight that SII presented its worst results in 2011 and 2012, reaching 15.8p.p. (95%CI: 14.1; 17.6) and 15.0p.p. (95%CI: 13.1; 16.9), respectively, among women with 12 years or more of education. There was a decrease in coverage of cervical cancer screening in most Brazilian regions and capitals from 2011 to 2020. In the period before and during the pandemic, a reduction in the outcome was observed in the South and Southeast regions, suggesting that the COVID-19 pandemic caused geographical inequalities in the coverage for this exam in Brazil.

Resumen: Este estudio tuvo como objetivo verificar la tendencia temporal y las desigualdades en el seguimiento autoinformado de cáncer de cuello uterino en las capitales brasileñas entre 2011 y 2020. Estudio de tendencias con datos de Vigilancia de Factores de Riesgo y Protección de Enfermedades Crónicas por Encuesta Telefónica (Vigitel) en el período de 2011 a 2020. El desenlace fue la prevalencia del examen citopatológico en los últimos tres años. Para estimar las desigualdades se utilizaron los índices de inequidad absoluto (slope index of inequality - SII) y de concentración (concentration index - CIX). Hubo tendencia a un aumento del desenlace en el período en estudio y un descenso en la mayoría de las regiones, capitales y en todos los grupos según el nivel educativo. Se observó un descenso en la cobertura en la mayoría de las regiones de Brasil. Se destaca que el SII presentó un peor resultado en 2011 y 2012, alcanzando 15,8p.p. (IC95%: 14,1; 17,6) y 15,0p.p. (IC95%: 13,1; 16,9), respectivamente, entre mujeres con 12 años o más de escolaridad. Hubo un descenso en la cobertura de la detección de cáncer de cuello uterino en la mayoría de las regiones y capitales brasileñas entre 2011 y 2020. En el período anterior y durante la pandemia, hubo una reducción en el desenlace para el país, en las regiones Sur y Sudeste, lo que apunta que la pandemia del COVID-19 provocó desigualdades geográficas en la cobertura de este examen a nivel nacional.

Adequação do cuidado a pessoas com hipertensão arterial no Brasil: Pesquisa Nacional de Saúde, 2013 e 2019 / Adecuación de la atención a personas con hipertensión arterial en Brasil: Encuesta Nacional de Salud, 2013 y 2019 / Adequacy of care for people with arterial hypertension in Brazil: National Health Survey, 2013 and 2019

Objetivo: Analisar a adequação do cuidado recebido por adultos e idosos com hipertensão arterial (HA) e sua associação com macrorregião nacional, características demográficas, socioeconômicas e do sistema de saúde, Brasil, 2013 e 2019. Métodos: Estudo transversal, com dados da Pesquisa Nacional de Saúde. Foram incluídas pessoas na idade de 18 anos ou mais, com diagnóstico de HA e consulta médica por esse motivo nos últimos três anos. Analisou-se a adequação do cuidado, construída a partir de 11 indicadores, por regressão de Poisson. Resultados: Em 2013, 11.129 pessoas com HA (25,3%; IC95% 24,5;26,1) receberam cuidado adequado, e em 2019, 19.107 (18,8%; IC95% 18,2;19,3). Indivíduos do quintil de melhor nível socioeconômico apresentaram prevalência de cuidado adequado 2,54 vezes maior (IC95% 2,03;3,17) em 2013, e 3,53 vezes maior (IC95% 2,94;4,23) em 2019, em relação aos de menor nível socioeconômico. Conclusão: O cuidado adequado diminuiu e as desigualdades econômicas intensificaram-se no período 2013-2019.

Objetivo: Analizar la adecuación de la atención recibida por adultos y ancianos con hipertensión arterial (HA), y su asociación con características regionales, demográficas, socioeconómicas y del sistema de salud, Brasil, 2013 y 2019. Métodos: Estudio transversal con datos de la Encuesta Nacional de Salud. Se incluyeron personas mayores de 18 años con diagnóstico de HA y consulta médica por este motivo en los últimos tres años. Se analizó la adecuación de la atención, construida a partir de 11 indicadores, por la regresión de Poisson. Resultados: En 2013, 11.129 personas con HA (25,3%; IC95% 24,5; 26,1) recibieron atención adecuada y, en 2019, 19.107 (18,8%; IC95% 18,2;19,3). Individuos del quintil con mejor nivel socioeconómico tuvieron una prevalencia de cuidado adecuado de 2,54 (IC95% 2,03;3,17) (2013) y 3,53 (IC95% 2,94;4,23) (2019) veces superior a los del menor nivel socioeconómico. Conclusión: Se identificó que la atención adecuada disminuyó y las desigualdades económicas se intensificaron en el período 2013-2019.

Objective: To analyze adequacy of care received by adults and elderly people with arterial hypertension, and its association with region of the country, demographic, socioeconomic and health system characteristics in Brazil in 2013 and 2019. Methods: This was a cross-sectional study using National Health Survey data. People aged ≥18 years with diagnosis of hypertension and medical consultation for this reason in the last three years were included. Adequacy of care was analyzed based on 11 indicators and using Poisson regression. Results: Adequate care was provided to 11,129 people with hypertension (25.3%; 95%CI 24.5;26.1) in 2013 and to 19,107 (18.8%; 95%CI 18.2;19.3) in 2019. Adequate care prevalence was 2.54 (95%CI 2.03;3.17) times higher in 2013, and 3.53 (95%CI 2.94;4.23) times higher in 2019 among individuals belonging to the highest socioeconomic quintile compared to those belonging to the poorest. Conclusion: We identified that care decreased, and economic inequalities intensified in the period 2013-2019.

Tendência da disponibilidade de vacinas no Brasil: PMAQ-AB 2012, 2014 e 2018 / Trend in the availability of vaccines in Brazil: PMAQ-AB, 2012, 2014, and 2018 / Tendencia de la disponibilidad de vacunas en Brasil: PMAQ-AB 2012, 2014 y 2018

O objetivo foi analisar a tendência da disponibilidade de vacinas no Brasil, em suas regiões e Unidades da Federação (UFs), de 2012 a 2018. Estudo transversal realizado com dados das unidades básicas avaliadas nos ciclos I (2012), II (2014) e III (2018) do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). Foi avaliada a disponibilidade das vacinas dupla dT, hepatite B, meningocócica C, poliomielite, pneumocócica 10, tríplice viral, tríplice bacteriana, tetravalente/pentavalente e rotavírus humano. Para identificação da tendência, foi realizada regressão de mínimos quadrados ponderada por variância para estimar mudanças anuais, em pontos percentuais. Também foi verificada a diferença relativa e absoluta da prevalência de vacinas. A amostra foi composta por 13.842 unidades básicas de saúde (UBS) no Ciclo I, 19.752 no Ciclo II e 25.152 no Ciclo III. Verificou-se tendência crescente da prevalência de disponibilidade de todas as vacinas investigadas no período avaliado, com aumento de 16p.p. entre 2012 e 2018, alcançando cerca de 70% em 2018. As regiões com maior tendência de aumento foram o Norte (2,9p.p.), Centro-oeste (2,1p.p.) e Nordeste (2,0p.p.). Destaque-se a tendência decrescente na disponibilidade (-3,3p.p.) e, também, nas diferenças absoluta e relativa negativas (-20p.p.; 0,68) verificadas no Rio de Janeiro. Identificou-se prevalência de disponibilidade de vacina baixa no Brasil, com disparidades entre as regiões, que ficam mais marcantes na avaliação das UFs.

The objective was to analyze the trend in the availability of vaccines in Brazil and its various regions and states from 2012 to 2018. This cross-sectional study used data from basic units assessed in cycles I (2012), II (2014), and III (2018) of the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB). We assessed the availability of the dT, hepatitis B, meningococcal C, polio, pneumococcal 10-valent, MMR, DPT, tetravalent/pentavalent, and human rotavirus vaccines. Identification of trend was performed with weighted least squares regression to estimate annual percent changes. We also verified the relative and absolute differences in prevalence of vaccines. The sample consisted of 13,842 basic health units in Cycle I, 19,752 in Cycle II, and 25,152 in Cycle III. An upward trend was seen in the prevalence of availability of all vaccines investigated during the period, with an increase of 16 percentage points from 2012 to 2018, reaching nearly 70% in 2018. The regions with the largest upward trend were the North (2.9p.p.), Central-West (2.1p.p.), and Northeast (2.0p.p.). There was a visible downward trend in both the availability (-3.3p.p.) and absolute and relative difference (-20p.p.; 0.68) in Rio de Janeiro State. The prevalence of availability of vaccines was low in Brazil, with disparities between regions that become even more pronounced when assessing specific states.

El objetivo fue analizar la tendencia de la disponibilidad de vacunas en Brasil, en sus regiones y Unidades de la Federación (UFs), de 2012 a 2018. Estudio transversal realizado con datos de las unidades básicas, evaluadas en los ciclos I (2012), II (2014) y III (2018) del Programa Nacional de Mejoría de Acceso y Calidad de la Atención Básica (PMAQ-AB). Se evaluó la disponibilidad de las vacunas doble dT, hepatitis B, meningocócica C, poliomielitis, neumocócica 10, triple viral, triple bacteriana, tetravalente/pentavalente y rotavirus humano. Para la identificación de la tendencia se realizó una regresión de mínimos cuadrados ponderada por variancia para estimar cambios anuales, en puntos porcentuales. También se verificó la diferencia relativa y absoluta de la prevalencia de vacunas. La muestra estuvo compuesta por 13.842 unidades basicas de salud en el Ciclo I, 19.752 en el Ciclo II y 25.152 en el Ciclo III. Se verificó la tendencia creciente de la prevalencia de disponibilidad de todas las vacunas investigadas en el período evaluado, con un aumento de 16p.p entre 2012 y 2018, alcanzando cerca de un 70% en 2018. Las regiones con mayor tendencia de aumento fueron el Norte (2,9p.p.), Centro-oeste (2,1p.p.) y Nordeste (2,0p.p.). Se destaca la tendencia decreciente en la disponibilidad (-3,3p.p.) y también en la diferencia absoluta y relativa negativas (-20p.p.; 0,68), verificadas en Río de Janeiro. Se identificó la prevalencia de una disponibilidad baja de vacunación en Brasil, con disparidades entre las regiones, que son más visibles en la evaluación de las UFs.

Desigualdades socioeconômicas no consumo alimentar da população idosa brasileira: Pesquisa Nacional de Saúde, 2019 / Socioeconomic inequalities in the food consumption of the elderly Brazilian population: National Health Survey, 2019

Resumo O consumo alimentar, quando realizado de forma não saudável, traz consequências para a saúde dos indivíduos, como uma maior ocorrência de excesso de peso e o agravamento de doenças crônicas prévias. O objetivo deste artigo foi avaliar as desigualdades sumárias no consumo alimentar da população idosa no Brasil. Trata-se de um estudo transversal, com dados da Pesquisa Nacional de Saúde de 2019. Foram avaliados os seguintes desfechos: consumo de feijão, verduras/legumes, frutas, leite, carnes, refrigerante, doces e sal. A principal variável de exposição foi escolaridade. Para mensuração da desigualdade foi realizada análise ajustada e também foram utilizados dois índices: slope index (SII) e o concentration index (CIX). Foram investigados 43.554 idosos. Identificou-se que os mais escolarizados tinham até 80,0% mais probabilidade de consumir verduras, frutas e leite, enquanto o consumo de feijão e de carnes foi até 50,0% menor nos mais escolarizados. As análises de desigualdade relativa e absoluta reforçam o menor consumo de alimentos considerados saudáveis entre os idosos menos escolarizados. Os resultados revelam iniquidades no consumo alimentar entre idosos, com maior magnitude nos alimentos reconhecidamente saudáveis.

Abstract Food consumption, when performed in an unhealthy manner, has consequences for the health of individuals, such as a higher incidence of excess weight and the exacerbation of pre-existing chronic diseases. The scope of this article was to assess summary inequalities in food consumption among the elderly population in Brazil. It involved a cross-sectional study, with data from the 2019 National Health Survey. The following outcomes were evaluated: consumption of beans, greens/vegetables, fruit, milk, meat, soda, candies and salt. The main exposure variable was education. An adjusted analysis was conducted and two indices were also used to measure inequality: the slope index (SII) and the concentration index (CIX). A total of 43,554 elderly people were investigated. It was identified that the more educated were 80% more likely to consume vegetables, fruit and milk, while the consumption of beans and meat was up to 50% lower among the less educated. The analyses of relative and absolute inequality reinforce the lower consumption of foods considered healthy among the less educated elderly individuals. The results reveal inequalities in food consumption among the elderly, with greater magnitude in food recognized as being healthy.

Motivation for participation in sports among Brazilian adults: National Household Sample Survey - 2015.

This article aims to describe the reasons for sport participation in the Brazilian adult population according to gender, age and schooling level. This is a cross-sectional study with data from a National Household Sample Survey - 2015. The reasons to practice or not practice sports in the previous year were obtained by questionnaire with predetermined answer options. All analyses were performed in Stata 12.1 and stratified by gender. The prevalence of sports participation for men and women were 31.7% and 16.9%, respectively. The most frequent reasons for sports participation among men were: having fun, quality of life and performance. Among women, the most frequent reasons were: quality of life, performance and medical recommendation. Regarding reasons for not practicing sports, the most reported ones were: lack of time (38.8% for men and 37.8% for women), not enjoying (34.8% for men and 35.3% for women) and health problem (20.3% for men and 17.9% for women). The study findings showed the most frequent reasons for sport participation in Brazil. Understanding these reasons and how they affect different age ranges and educational levels may contribute to improve strategic planning to promote sports in middle-income countries.