Time trend analysis and impacts of the COVID-19 pandemic on mammography and Papanicolaou test coverage in Brazilian state capitals.

BACKGROUND: Breast and cervical cancer are major public health issues globally. The reduction in incidence and mortality rates of these cancers is linked to effective prevention, early detection, and appropriate treatment measures. This study aims to analyze the temporal trends in the prevalence of mammography and Papanicolaou test coverage among women living in Brazilian state capitals between 2007 and 2023, and to compare the coverage of these tests before and during the Covid-19 pandemic. METHODS: A time series study was conducted using data from the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey from 2007 to 2023. The variables analyzed included mammography and Papanicolaou test coverage according to education level, age group, race/skin color, regions, and Brazilian capitals. The Prais-Winsten regression model was used to analyze the time series, and Student's t-test was employed to compare the prevalence rates between 2019 and 2023. RESULTS: Between 2007 and 2023, mammography coverage showed a stationary trend (71.1% in 2007 and 73.1% in 2023; p-value = 0.75) with a declining trend observed among women with 12 years or more of education (APC= -0.52% 95%CI -1.01%; -0.02%). Papanicolaou test coverage for all women aged between 25 and 64 exhibited a downward trend from 82% in 2007 to 76.8% in 2023 (APC= -0.45% 95%CI -0.76%; -0.13%). This decline was also noticed among those with 9 years or more of education; in the 25 to 44 age group; among women with white and mixed race; and in the Northeast, Central-West, Southeast, and South regions. When comparing coverage before and during Covid-19 pandemic, a reduction was noted for both tests. CONCLUSIONS: Over the years, there has been stability in mammography coverage and a decline in Papanicolaou test. The COVID-19 pandemic negatively impacted the number of these tests carried out among women, highlighting the importance of actions aimed at increasing coverage, especially among the most vulnerable groups.

Multiple behavioral risk factors for non-communicable diseases among the adolescent population in Brazil: the analysis derived from the Brazilian national survey of school health 2019.

BACKGROUND: Health risk behaviors often emerge or intensify during adolescence and tend to co-occur, exposing individuals to an even greater risk for the development of non-communicable diseases (NCDs). The likelihood of exhibiting multiple health risk factors also increases throughout life and is associated with sociodemographic characteristics contributing to their escalation and severity. In this context, the objective of this study was to analyze the association between sociodemographic characteristics and multiple behavioral risk factors for non-communicable diseases among the adolescent population in Brazil. METHODS: This cross-sectional study utilized data from the Brazilian National Survey of School Health 2019. The sample comprised 121,580 adolescents aged 13 to 17. The analyzed variables included irregular intake of fruits and vegetables, regular consumption of soft drinks and treats, insufficient physical activity, sedentary lifestyle, cigarette smoking, and alcohol consumption. To analyze MBRFs, a classification ranging from zero to five was created, and associations were estimated using Odds Ratio (OR) with the respective 95% confidence interval (CI). The Backward method was employed for the multivariate regression model, utilizing ordinal logistic regression. RESULTS: Adolescents without behavioral risk factors for NCDs constituted only 3.9% (95% CI 3.7-4.1). The most prevalent categories were two and three MBRFs, accounting for 28.3% (95% CI: 27.7-28.8) and 27.0% (95% CI: 26.5-27.5), respectively. Adolescents aged 16 and 17 (ORadj: 1.39; 95% CI: 1.32-1.48), residing in the Brazilian Southeast (ORadj: 1.66; 95% CI: 1.52-1.81), and those reporting poor or very poor self-rated health (ORadj: 2.05; 95% CI: 1.87-2.25) were more likely to exhibit multiple behavioral risk factors. Conversely, male adolescents (adjusted OR: 0.65; 95% CI: 0.62-0.69), those of mixed race (adjusted OR: 0.92; 95% CI: 0.87-0.97), and residents of rural areas (adjusted OR: 0.76; 95% CI: 0.70-0.84) were less likely to manifest MBRFs for NCDs. CONCLUSION: The majority of adolescents displayed MBRFs for NCDs, positively associated with age, region, and perceived health status. This underscores the necessity for healthcare promotional interventions throughout the life cycle, as these behaviors may persist into adulthood.

Evolution of mortality rates among women of reproductive age in Brazilian municipalities: an ecological analysis using Global Burden of Disease estimates.

OBJECTIVES: Women's mortality at a reproductive age has been a global concern, and its decrease has been incorporated as a target of the UN Sustainable Development Goals. The aim of this study was to describe the spatial-temporal evolution of mortality rates among women of reproductive age in Brazilian municipalities by groups of causes and socioeconomic indicators from 2000 to 2018. STUDY DESIGN: Ecological analysis. METHODS: This work was an ecological, descriptive study that analyzed estimates of mortality rates among women of reproductive age (15-49 years) by main groups of causes of death from the Global Burden of Disease (GBD) study in three consecutive trienniums, T1 (2000-2002), T2 (2009-2011), and T3 (2016-2018). To quantify the temporal evolution in mortality rates, the present study calculated the percentage change for each triennium. The spatial analysis of mortality rates was carried out using Moran's index. The Pearson coefficient was used to analyze the correlation between the data. RESULTS: A significant decline in mortality rates was found for all groups of causes in all regions of the country. Despite the downward trend, the percentage change from 2009 to 2011 to 2016 to 2018 showed a decrease in the group of Noncommunicable Diseases (NCDs) and external causes. The decline in mortality rates of women due to external causes showed only a minimal change in the North and Northeast regions from T2 to T3, whereas a cluster of neighboring municipalities with high mortality rates persisted in the municipalities of the South region and in the state of Roraima. The ranking of the main causes of death in Brazilian municipalities showed an increase in neoplasms in detriment to cardiovascular diseases (CVDs). CONCLUSIONS: The main causes of death in women of reproductive age at a more local level could be used to recognize inequalities and to develop interventions aimed at tackling premature and preventable deaths.

[Calculation of the alcohol per capita consumption in Brazil: using national dataCálculo del indicador del consumo de alcohol per cápita en Brasil: uso de datos nacionales]. / Cálculo do indicador de consumo de álcool per capita no Brasil: uso de dados nacionais.

Objective: To calculate the alcohol per capita consumption (APC) in Brazil (Brazil APC) using national data and to establish the Brazil APC as gold standard for the country, replacing the indicator previously calculated by the World Health Organization (WHO) based on international data. Method: The Brazilian public data sources necessary for calculating the recorded APC were selected, and the alcohol concentration was defined by beverage category. For the variables of tourist APC and unrecorded APC, which are unavailable in Brazil, estimates from the United Nations (UN) and the WHO were used. The Brazil APC indicator was calculated and compared to the indicator produced by the WHO through analysis of the medians obtained for the period from 2005 to 2020. Results: The national alcohol consumption indicator was 9.2 liters per capita in 2005, reaching 9.8 in 2020. The WHO indicator showed a consumption of 8.4 liters per capita in 2005, decreasing until 2016 and slightly increasing to 7.8 in 2020. Conclusion: The Brazil APC was calculated based on national sources and showed a distinct trend compared to the WHO indicator, which showed a decrease. The regular and transparent provision of this indicator through government channels will support the development of policies to address alcohol consumption in the country.

Objetivo: Calcular el indicador del consumo de alcohol per cápita en Brasil a partir de datos nacionales, con miras a establecerlo como patrón de referencia para el país en sustitución del indicador calculado anteriormente por la Organización Mundial de la Salud a partir de datos internacionales. Métodos: Se seleccionaron las fuentes públicas de datos de Brasil necesarias para estructurar el cálculo del consumo de alcohol per cápita registrado y se definió la concentración de alcohol por clase de bebida. Para las variables de consumo de alcohol per cápita por parte de turistas y consumo per cápita no registrado, que no están disponibles en Brasil, se utilizaron estimaciones de las Naciones Unidas y de la Organización Mundial de la Salud. Se calculó el indicador del consumo de alcohol per cápita en Brasil y se comparó con el indicador elaborado por la OMS mediante un análisis de las medianas correspondientes al período 2005-2020. Resultados: El indicador nacional del consumo de alcohol fue de 9,2 litros per cápita en el 2005, con un aumento a 9,8 en el 2020. El indicador de la Organización Mundial de la Salud mostró un consumo de 8,4 litros per cápita en el 2005, con una reducción hasta el 2016 y un leve aumento a 7,8 en el 2020. Conclusión: Se calculó el consumo de alcohol per cápita en Brasil a partir de fuentes nacionales, lo que mostró una tendencia distinta de la tendencia descendente del indicador de la Organización Mundial de la Salud. La disponibilidad transparente y regular de este indicador por medio de los canales gubernamentales permitirá su seguimiento, con lo cual se podrán formular políticas para enfrentar el consumo de alcohol en el país.

Lack of knowledge about the human papillomavirus vaccine among Brazilian adolescents: A cross-sectional study.

To analyze the distribution and factors associated with lack of knowledge about the human papillomavirus (HPV) vaccine among Brazilian adolescents.Cross-sectional study using the 2019 National School Health Survey among 17,805 Brazilian students of public and private schools, aged 13-17 years. The outcome variable was "lack of knowledge about the HPV vaccine" and the explanatory variables were sociodemographic, behaviors, knowledge, and health conditions. Logistic regression model was used to calculate Odds Ratio (OR) and 95% confidence intervals (95%CI). Spatial analysis techniques were used to determine the formation of clusters in the federated units with similar proportions of adolescents who were unaware of the vaccine. The lack of knowledge about the HPV vaccine was reported by 45.54% of Brazilian students. There was a higher chance of lack of knowledge having had sexual intercourse (OR 1.43; 95% CI 1.20-1.70); attending public school (OR 1.72; 95%CI 1.47-2.02) and located in the Northeast Region (OR 1.35; 95%CI 1.08-1.69). The lower chance of lack of knowledge were female gender (OR 0.41; 95% CI 0.35-0.48), higher maternal education (OR 0.62; 95% CI 0.50-0.77) self-rated health as Poor/very poor (OR 0.64; 95% CI 0.49-0.86) and receiving contraceptive counseling (OR 0.77; 95% CI 0.65-0.91). The proportion of lack of knowledge about the HPV vaccine was higher with the formation of High-High spatial clusters in the states of Maranhão, Piauí, and Pernambuco. Sociodemographic, health, and behavioral conditions and knowledge of students, as well as school characteristics, were associated with lack of knowledge about the HPV vaccine. A higher frequency of lack of knowledge about the HPV vaccine among adolescents was found in the states of the Northeastern Region.

The Association Between Depressive Symptoms, Access to Diabetes Care, and Glycemic Control in Five Middle-Income Countries.

OBJECTIVE: The relationship between depression, diabetes, and access to diabetes care is established in high-income countries (HICs) but not in middle-income countries (MICs), where contexts and health systems differ and may impact this relationship. In this study, we investigate access to diabetes care for individuals with and without depressive symptoms in MICs. RESEARCH DESIGN AND METHODS: We analyzed pooled data from nationally representative household surveys across Brazil, Chile, China, Indonesia, and Mexico. Validated survey tools Center for Epidemiologic Studies Depression Scale Revised, Composite International Diagnostic Interview, Short Form, and Patient Health Questionnaire identified participants with depressive symptoms. Diabetes, defined per World Health Organization Package of Essential Noncommunicable Disease Interventions guidelines, included self-reported medication use and biochemical data. The primary focus was on tracking diabetes care progression through the stages of diagnosis, treatment, and glycemic control. Descriptive and multivariable logistic regression analyses, accounting for gender, age, education, and BMI, examined diabetes prevalence and care continuum progression. RESULTS: The pooled sample included 18,301 individuals aged 50 years and above; 3,309 (18.1%) had diabetes, and 3,934 (21.5%) exhibited depressive symptoms. Diabetes prevalence was insignificantly higher among those with depressive symptoms (28.9%) compared with those without (23.8%, P = 0.071). Co-occurrence of diabetes and depression was associated with increased odds of diabetes detection (odds ratio [OR] 1.398, P < 0.001) and treatment (OR 1.344, P < 0.001), but not with higher odds of glycemic control (OR 0.913, P = 0.377). CONCLUSIONS: In MICs, individuals aged 50 years and older with diabetes and depression showed heightened diabetes identification and treatment probabilities, unlike patterns seen in HICs. This underscores the unique interplay of these conditions in different income settings.

Individual characteristics associated with road traffic collisions and healthcare seeking in low- and middle-income countries and territories.

Incidence of road traffic collisions (RTCs), types of users involved, and healthcare requirement afterwards are essential information for efficient policy making. We analysed individual-level data from nationally representative surveys conducted in low- or middle-income countries (LMICs) between 2008-2019. We describe the weighted incidence of non-fatal RTC in the past 12 months, type of road user involved, and incidence of traffic injuries requiring medical attention. Multivariable logistic regressions were done to evaluate associated sociodemographic and economic characteristics, and alcohol use. Data were included from 90,790 individuals from 15 countries or territories. The non-fatal RTC incidence in participants aged 24-65 years was 5.2% (95% CI: 4.6-5.9), with significant differences dependent on country income status. Drivers, passengers, pedestrians and cyclists composed 37.2%, 40.3%, 11.3% and 11.2% of RTCs, respectively. The distribution of road user type varied with country income status, with divers increasing and cyclists decreasing with increasing country income status. Type of road users involved in RTCs also varied by the age and sex of the person involved, with a greater proportion of males than females involved as drivers, and a reverse pattern for pedestrians. In multivariable analysis, RTC incidence was associated with younger age, male sex, being single, and having achieved higher levels of education; there was no association with alcohol use. In a sensitivity analysis including respondents aged 18-64 years, results were similar, however, there was an association of RTC incidence with alcohol use. The incidence of injuries requiring medical attention was 1.8% (1.6-2.1). In multivariable analyses, requiring medical attention was associated with younger age, male sex, and higher wealth quintile. We found remarkable heterogeneity in RTC incidence, the type of road users involved, and the requirement for medical attention after injuries depending on country income status and socio-demographic characteristics. Targeted data-informed approaches are needed to prevent and manage RTCs.

Factors associated with concurrent alcohol, tobacco and illicit drug use: 2019 National School-Based Health Survey. / Fatores associados ao policonsumo de álcool, tabaco e drogas ilícitas: Pesquisa Nacional de Saúde do Escolar 2019.

The aim of this study was to analyze the factors associated with concurrent alcohol, tobacco and illicit drug use among Brazilian schoolchildren aged 13-17. We conducted a cross-sectional study using data from the 2019 National School-Based Health Survey. The outcome was use of the three substances during the last 30 days. Hierarchical multiple logistic regression was carried out with independent variables grouped into four blocks: sociodemographic characteristics; family context; behavioral aspects; and stressors. Variables with p<0.05 were retained in the final model. The prevalence of concurrent substance use was 3.3%. Being male, living in the Midwest, South and Southeast, skipping school without parent permission, parents not knowing what their children do in their free time, having parents who smoke, having experienced physical aggression from parents, feeling that life is not worth living, trying drinking and illicit drugs before the age of 13, and having friends who drink alcohol, smoke and use drugs in their presence remained associated with the outcome in the final model. The findings reveal high prevalence of concurrent alcohol, cigarette and illicit drug use among adolescents and that poly use is associated with sociodemographic, family, and behavioral factors and stressors.

Objetivou-se analisar os fatores associados ao policonsumo de álcool, tabaco e drogas ilícitas, entre adolescentes escolares brasileiros de 13 a 17 anos. Estudo transversal, com dados da Pesquisa Nacional de Saúde do Escolar (2019). A variável desfecho foi o relato de consumo das três substâncias nos últimos 30 dias. As variáveis independentes foram agrupadas em quatro blocos: características sociodemográficas; contexto familiar; situações estressoras; aspectos comportamentais. Foi realizada análise de regressão logística múltipla hierarquizada, permanecendo no modelo final as variáveis com p<0,05. A prevalência de policonsumo em adolescentes escolares foi 3,3%. No modelo final, sexo masculino, morar na região Centro-Oeste, Sul e Sudeste, faltar a escola sem permissão, pais não saberem o que fazem no tempo livre, ter pais fumantes, sofrer agressão física pelos pais, sentir que a vida não vale a pena ser vivida, experimentar bebida alcoólica e drogas ilícitas antes dos 13 anos, ter amigos que bebem bebida alcoólica, fumam e usam drogas na sua presença permaneceram associados ao desfecho. Os dados mostram alta prevalência de policonsumo de três substâncias entre adolescentes e sua associação a fatores sociodemográficos, familiares, comportamentais e a eventos estressantes.

Hypertension care cascades and reducing inequities in cardiovascular disease in low- and middle-income countries.

Improving hypertension control in low- and middle-income countries has uncertain implications across socioeconomic groups. In this study, we simulated improvements in the hypertension care cascade and evaluated the distributional benefits across wealth quintiles in 44 low- and middle-income countries using individual-level data from nationally representative, cross-sectional surveys. We raised diagnosis (diagnosis scenario) and treatment (treatment scenario) levels for all wealth quintiles to match the best-performing country quintile and estimated the change in 10-year cardiovascular disease (CVD) risk of individuals initiated on treatment. We observed greater health benefits among bottom wealth quintiles in middle-income countries and in countries with larger baseline disparities in hypertension management. Lower-middle-income countries would see the greatest absolute benefits among the bottom quintiles under the treatment scenario (29.1 CVD cases averted per 1,000 people living with hypertension in the bottom quintile (Q1) versus 17.2 in the top quintile (Q5)), and the proportion of total CVD cases averted would be largest among the lowest quintiles in upper-middle-income countries under both diagnosis (32.0% of averted cases in Q1 versus 11.9% in Q5) and treatment (29.7% of averted cases in Q1 versus 14.0% in Q5) scenarios. Targeted improvements in hypertension diagnosis and treatment could substantially reduce socioeconomic-based inequalities in CVD burden in low- and middle-income countries.

Insegurança alimentar e nutricional e os comportamentos de risco e proteção para saúde em adolescentes durante a pandemia de covid-19 / Food and nutritional insecurity and health risk behaviors in adolescents during the COVID-19 pandemic

RESUMO A pandemia de covid-19 reduziu o acesso aos alimentos e aumentou a insegurança alimentar. Objetivouse analisar a prevalência de Insegurança Alimentar e Nutricional (IAN) em adolescentes brasileiros durante a pandemia de covid-19 segundo características sociodemográficas e examinar a associação entre IAN e comportamentos de risco e proteção em adolescentes brasileiros durante esse período. Estudo transversal com dados da 'ConVid Adolescentes - Pesquisa de Comportamentos', realizada entre junho e outubro de 2020, utilizando-se um questionário autoaplicado por meio de celular ou computador. A população foi adolescentes de 12 a 17 anos, totalizando 9.470. Utilizou-se a Razão de Prevalência (RP) e Intervalo de Confiança de 95% (IC95%), por meio da regressão de Poisson com variância robusta. A prevalência de IAN (26,1%) foi mais elevada entre os adolescentes da raça/cor preta e parda e que estudam em escola pública. Os adolescentes que relataram IAN tiveram menor consumo de hortaliças e frutas, menor prática de atividade física e maior uso de cigarros e álcool. A IAN foi mais prevalente em adolescentes com piores condições socioeconômicas, e, adolescentes com IAN apresentaram maior frequência de comportamentos de risco para a saúde evidenciando a importância de políticas públicas intersetoriais para a redução de desigualdades.

ABSTRACT The COVID-19 pandemic has reduced access to food and increased food insecurity. The objectives were to analyse the prevalence of Food and Nutritional Insecurity (FNI) in Brazilian adolescents during the COVID-19 pandemic according to sociodemographic characteristics and to examine the association between FNI and risk and protective behaviours in Brazilian adolescents during the that period. Cross-sectional study with data from the 'ConVid teenagers - Behaviour Survey,' carried out between June and October 2020, using a self-administered questionnaire via mobile phone or computer. The population was made up of teenagers aged 12 to 17, totalling 9,470. The Prevalence Ratio (PR) and 95% Confidence Interval (95% CI) were used, using Poisson regression with robust variance. The prevalence of FNI (26.1%) was higher among adolescents of black and mixed race/colour and who study in public schools. Adolescents who reported FNI had lower consumption of vegetables and fruits, less physical activity, and greater use of cigarettes and alcohol. FNI was more prevalent in adolescents with worse socioeconomic conditions, and adolescents with FNI showed a higher frequency of health risk behaviours, highlighting the importance of intersectoral public policies to reduce inequalities.

Associação entre avaliação elevada da Atenção Primária à Saúde, estado de saúde e uso dos serviços de saúde no Brasil / Association between high assessment of Primary Health Care and health state and use of health services in Brazil

RESUMO O estudo descreveu as características dos indivíduos que utilizam os serviços da Atenção Primária à Saúde (APS) e avaliou a associação entre a avaliação elevada dos atributos da APS, sob a ótica dos usuários, com o estado de saúde e o uso dos serviços de saúde no Brasil. Trata-se de um estudo transversal que analisou dados da Pesquisa Nacional de Saúde 2019, com amostra de 9.562 adultos que responderam ao Primary Care Assessment Tool (PCATool). Foi testada a associação entre avaliação elevada da APS (escore geral ≥ 6,6) e estado de saúde e uso dos serviços. Verificou-se que os usuários adultos que mais utilizam a APS pública têm entre 40 e 59 anos, são mulheres, de baixa escolaridade e pardos. Os que melhor avaliaram a APS foram indivíduos que utilizaram o mesmo serviço, procuraram serviços nas últimas duas semanas e se internaram. Maior uso dos serviços aponta para melhor avaliação da APS.

ABSTRACT The present study described the characteristics of individuals who use Primary Health Care (PHC) services and evaluated the association between the high assessment of PHC attributes, from the perspective of users, with health conditions and the use of health services in Brazil. This work is a cross-sectional study that analyzed data from the 2019 National Health Survey, in which 9,562 adults responded to the Primary Care Assessment Tool (PCATool). The association between high PHC assessment (general score ≥ 6.6) and health conditions and the use of services was tested, and it was found that the adult users who most use public PHC are between 40 and 59 years of age, women, with a low level of education, and brown. Those who best evaluated PHC were individuals who used the same service, who sought out services in the last 2 weeks, and who had been hospitalized. The greater use of health services points to a better assessment of PHC.

Fatores associados ao policonsumo de álcool, tabaco e drogas ilícitas: Pesquisa Nacional de Saúde do Escolar 2019 / Factors associated with concurrent alcohol, tobacco and illicit drug use: 2019 National School-Based Health Survey

Resumo Objetivou-se analisar os fatores associados ao policonsumo de álcool, tabaco e drogas ilícitas, entre adolescentes escolares brasileiros de 13 a 17 anos. Estudo transversal, com dados da Pesquisa Nacional de Saúde do Escolar (2019). A variável desfecho foi o relato de consumo das três substâncias nos últimos 30 dias. As variáveis independentes foram agrupadas em quatro blocos: características sociodemográficas; contexto familiar; situações estressoras; aspectos comportamentais. Foi realizada análise de regressão logística múltipla hierarquizada, permanecendo no modelo final as variáveis com p<0,05. A prevalência de policonsumo em adolescentes escolares foi 3,3%. No modelo final, sexo masculino, morar na região Centro-Oeste, Sul e Sudeste, faltar a escola sem permissão, pais não saberem o que fazem no tempo livre, ter pais fumantes, sofrer agressão física pelos pais, sentir que a vida não vale a pena ser vivida, experimentar bebida alcoólica e drogas ilícitas antes dos 13 anos, ter amigos que bebem bebida alcoólica, fumam e usam drogas na sua presença permaneceram associados ao desfecho. Os dados mostram alta prevalência de policonsumo de três substâncias entre adolescentes e sua associação a fatores sociodemográficos, familiares, comportamentais e a eventos estressantes.

Abstract The aim of this study was to analyze the factors associated with concurrent alcohol, tobacco and illicit drug use among Brazilian schoolchildren aged 13-17. We conducted a cross-sectional study using data from the 2019 National School-Based Health Survey. The outcome was use of the three substances during the last 30 days. Hierarchical multiple logistic regression was carried out with independent variables grouped into four blocks: sociodemographic characteristics; family context; behavioral aspects; and stressors. Variables with p<0.05 were retained in the final model. The prevalence of concurrent substance use was 3.3%. Being male, living in the Midwest, South and Southeast, skipping school without parent permission, parents not knowing what their children do in their free time, having parents who smoke, having experienced physical aggression from parents, feeling that life is not worth living, trying drinking and illicit drugs before the age of 13, and having friends who drink alcohol, smoke and use drugs in their presence remained associated with the outcome in the final model. The findings reveal high prevalence of concurrent alcohol, cigarette and illicit drug use among adolescents and that poly use is associated with sociodemographic, family, and behavioral factors and stressors.

Mortalidade e carga do câncer de laringe atribuíveis aos riscos ocupacionais no Brasil: estudo da Carga Global de Doença, 2019 / Laryngeal cancer mortality and burden attributable to occupational risks in Brazil: 2019 Global Burden of Disease

Resumo Objetivo: descrever a mortalidade e os anos de vida ajustados pela incapacidade disability-adjusted life years - DALYs) para câncer de laringe no Brasil atribuíveis a fatores de risco ocupacionais e comportamentais. Métodos: estudo ecológico com dados do estudo Global Burden of Disease 2019. Foram obtidas taxas de mortalidade e de DALYs para o câncer de laringe atribuíveis aos riscos ocupacionais (ácido sulfúrico e amianto) e comportamentais (tabaco e álcool), de 1990 e 2019. Resultados: no Brasil, em 2019, a taxa de mortalidade por câncer de laringe atribuível aos riscos ocupacionais (ácido sulfúrico e amianto) foi 0,28 (II95%: 0,17;0,43) no sexo masculino e 0,03 (II95%: 0,02;0,04) no feminino, e a de DALYs foi 7,33 (II95%: 4,28;11,44) e 0,64 (II95%: 0,35;0,03), respectivamente. O ácido sulfúrico foi o principal risco ocupacional para a doença. Houve redução das taxas atribuíveis ao tabaco (mortalidade:-45,83%; DALYs:-47,36%) e aos riscos ocupacionais (mortalidade:-23,20%; DALYs:-26,31%), no Brasil, com aumento em alguns estados das regiões Norte e Nordeste. Conclusão: houve redução na mortalidade e na carga do câncer de laringe atribuível aos fatores ocupacionais no período, porém menor em comparação ao tabagismo, reforçando a importância de ações para reduzir o impacto dos riscos ocupacionais, como as medidas regulatórias aplicadas ao tabaco.

Abstract Objective: to describe mortality and disability-adjusted life years (DALYs) due to laryngeal cancer attributable to occupational and behavioral risk factors in Brazil. Methods: this is an ecological study with data from the 2019 Global Burden of Disease. Mortality and DALY rates for laryngeal cancer attributable to occupational (sulfuric acid and asbestos) and behavioral (tobacco and alcohol) risks were obtained from 1990 and 2019. Results: in 2019, the mortality rate from laryngeal cancer attributable to occupational hazards (sulfuric acid and asbestos) totaled 0.28 (95%UI: 0.17; 0.43) and 0.03 (95%UI: 0.02; 0.04), whereas and DALY rates, 7.33 (95%UI: 4.28; 11.44) and 0.64 (95%UI: 0.35; 0.03) in men and women in Brazil, respectively. Sulfuric acid configured the main occupational risk for the disease. The rates attributable to tobacco (mortality: −45.83%; DALYs: −47.36%) and occupational hazards (mortality: −23.20%; DALYs: −26.31%) decreased in Brazil but increased in some Northern and Northeastern states. Conclusion: laryngeal cancer mortality and burden attributable to occupational factors decreased in the period (although less than that for smoking), reinforcing the importance of actions to reduce the impact of occupational risks, such as the regulatory measures applied to tobacco.

Diabetes gestacional autorreferido - uma análise da Pesquisa Nacional de Saúde / Self-reported gestational diabetes - an analysis of the National Health Survey

Resumo Introdução O diabetes mellitus gestacional é definido como qualquer grau de intolerância à glicose, diagnosticado pela primeira vez durante a gestação, podendo ou não persistir após o parto. Sua prevalência ainda é conflitante, mas os riscos oferecidos a mãe e feto são diversos. Objetivo Identificar as respostas positivas de mulheres sobre um diagnóstico de diabetes recebido na gestação e relacioná-lo a características sociodemográficas e do pré-natal, além de descrever as orientações recebidas frente ao diagnóstico. Método Estudo com característica transversal que utiliza dados da Pesquisa Nacional de Saúde 2013, conforme o autorrelato de diagnóstico de diabetes gestacional. Realizou-se análise bivariada e cálculo das prevalências e razões de prevalência, com intervalo de confiança de 95% (IC95%), considerando plano de amostragem complexa. Resultados O diagnóstico de diabetes mellitus gestacional no período pré-natal foi relatado por 106 mulheres, com uma prevalência ponderada de 6,6% (IC95% 5,0-8,5). Verificou-se associação entre o relato de diagnóstico na gestação com maior idade e cor não branca. A maioria das mulheres diagnosticadas recebeu orientações quanto aos riscos da doença, mas poucas foram encaminhadas para consulta com especialista. Conclusão Os resultados detalhados da PNS fornecem estimativas populacionais sobre a magnitude da doença e possibilitam identificar o conjunto de fatores associados ao DMG.

Abstract Background Gestational diabetes mellitus is defined as any degree of glucose intolerance that is first diagnosed during pregnancy and may or may not persist after delivery. Its prevalence is still conflicting, but the risks offered to mother and fetus are diverse. Objective To identify the positive responses of women about a diagnosis of diabetes received during pregnancy and to relate it to sociodemographic and prenatal characteristics, in addition to describing the orientations received regarding the diagnosis. Method A cross-sectional study that uses data from the 2013 National Health Survey according to the self-reported gestational diabetes diagnosis. A bivariate analysis was performed, and prevalence and prevalence rates with a 95% confidence interval (95% CI) were calculated, considering a complex sampling plan. Results The diagnosis of prenatal gestational diabetes mellitus was reported by 106 women, with a weighted prevalence of 6.6% (95% CI 5.0-8.5). There was an association between the diagnosis report in older pregnancy and non-white color. Most diagnosed women received guidance on the risks of the disease, but few were referred for specialist consultation. Conclusion The detailed results of the PNS provide population estimates of the magnitude of the disease and make it possible to identify the set of factors associated with GDM.

Tendência de realização da mamografia e fatores associados em mulheres de 50 a 69 anos / Mammography trend and associated factors in women from 50 to 69 years

Resumo Introdução A mamografia é o principal método de detecção precoce de neoplasias mamárias. Objetivou-se conhecer a tendência temporal de realização da mamografia e identificar os fatores associados à realização desse exame em algum momento da vida e nos últimos dois anos. Objetivo Descrever a tendência temporal de realização da mamografia e identificar fatores associados à realização desse exame em algum momento da vida e nos últimos dois anos. Método Estudo transversal utilizando dados autorreferidos por mulheres, de 50 a 69 anos, oriundos do Vigitel. Para análise da tendência de realização da mamografia, tanto em algum momento da vida quanto nos últimos dois anos, foram analisados dados de 2007 a 2015 da cidade de João Pessoa, Paraíba, por meio de regressão linear simples, e, para identificação dos fatores associados, foram estimadas razões de prevalências utilizando-se da regressão de Poisson com dados de 2015. Resultados A prevalência de realização da mamografia, de 2007 a 2015, aumentou nos dois desfechos. Entre as variáveis analisadas, apenas a posse de plano de saúde manteve-se associada à realização da mamografia em algum momento da vida. Para a realização do exame nos últimos dois anos, mantiveram-se associados o estado civil casada/união estável e a posse de plano de saúde. Conclusão É necessário haver ações prioritárias nos serviços públicos de saúde, com a ampliação do acesso à solicitação e à realização da mamografia, garantindo acesso igualitário entre todas as mulheres.

Abstract Background Mammography is the main method for the early detection of breast cancer. The objective of this study was to learn about the temporal trend for mammography and identify factors associated with the examination at some point in life and in the last two years. Objective Describe the temporal trend of mammograms and identify factors associated with this exam at some point in life and in the last two years. Method A cross-sectional study was carried out using self-reported data from women aged 50 to 69 years from Vigitel. To analyze the tendency to perform mammography, both at some point in life and in the last two years, data from 2007 to 2015 in the city of João Pessoa, Paraíba, were analyzed using simple linear regression, and to identify the associated factors, prevalence ratios were estimated using Poisson regression with data from 2015. Results The prevalence of mammography, from 2007 to 2015, increased in both outcomes. Among the variables analyzed, only possession of a health plan remained associated with mammography at some point in life. For the examination in the last two years, marital status/stable union, and possession of a health plan remained associated. Conclusion Priority actions are needed in public health services, with increased access to requests and the performance of mammography, guaranteeing equal access among all women.

Desempenho da gestão organizacional dos serviços hospitalares no Brasil / Organizational management performance of hospital services in Brazil / Desempeño de la gestión organizativa de los servicios hospitalarios en Brasil

Objetivo: avaliar o Desempenho da Gestão Organizacional dos Serviços Hospitalares no Brasil. Método: estudo transversal que utilizou dados do Programa Nacional de Avaliação dos Serviços de Saúde-PNASS 2015-2016 para avaliar o Desempenho da Gestão Organizacional de 1.665 hospitais do Brasil. Foram utilizados 30 itens de verificação distribuídos em 5 critérios (Gestão de Contratos; Gestão de Pessoas; Gestão da Informação; Planejamento e Organização; e Modelo Organizacional), que compuseram um escore de avaliação. O desempenho foi avaliado segundo os indicadores: porte hospitalar; nível de complexidade; esfera administrativa; tipo de gestão; e região do país. Verificou-se associação entre Desempenho da Gestão Organizacional dos hospitais com os indicadores Taxa de Ocupação, Média de Permanência e Valor Médio da AIH. Utilizou-se Análise de Componentes Principais para verificar a relação de dependência entre as variáveis e explicar a variabilidade dos dados. Foi utilizado o modelo de regressão logística ajustado para verificar variáveis que melhor explicam o Desempenho da Gestão Organizacional. Resultados: a média de Desempenho da Gestão Organizacional dos hospitais foi 63,83. Os melhores desempenhos estão nos hospitais da região Sul, de nível de Complexidade 8, acima de 150 leitos, de Esfera Administrativa Público Federal e de Gestão Estadual. Na análise de regressão logística, o desempenho se mostrou associado com: Taxa de Ocupação (p<9.87E-09), Porte hospitalar (p<4.49E-10), gestão municipal (p<0.004), Nível Hierárquico Nível 7 (p<0.042), Nível 8 (p<0.022) região Sul (p<0.004), Sudeste (p<0.002). Conclusão: o PNASS se mostrou adequado para avaliar o desempenho da gestão dos hospitais, sendo constatada relação entre melhor desempenho e maior porte e complexidade do hospital.(AU)

Objective: to assess the organizational management performance of hospital services in Brazil. Method: a cross-sectional study that resorted to data from the 2015-2016 National Program for the Evaluation of Health Services (Programa Nacional de Avaliação dos Serviços de Saúde, PNASS) to assess the Organizational Management Performance in 1,665 Brazilian hospitals. A total of 30 verification items distributed into 5 criteria (Contract Management; People Management; Information Management; Planning and Organization; and Organizational Model) were used, which comprised an evaluation score. Performance was assessed according to the following indicators: hospital size; complexity level; administrative sphere; type of management; and region of the country. An association was verified between the hospitals' Organizational Management Performance and the Occupancy Rate, Mean Hospitalization Time and Mean HA Value indicators. Principal Components Analysis was used to verify the dependence relationship between the variables and to explain data variability. An adjusted logistic regression model was used to verify variable that best explain Organizational Management Performance. Results: the hospitals' mean Organizational Management Performance was 63.83. The best performance levels correspond to the hospitals from the South region, Complexity level 8, more than 150 beds, belonging to the Federal Public Administrative Sphere and with State Management. In the logistic regression analysis, performance proved to be associated with: Occupancy Rate (p<9.87E-09), Hospital size (p<4.49E-10), Municipal Management (p<0.004), Hierarchical Level 7 (p<0.042), Level 8 (p<0.022), South region (p<0.004), and Southeast region (p<0.002). Conclusion: the PNASS proved to be adequate to assess the hospitals' management performance, verifying a relationship between better performance and larger hospital size and higher complexity.(AU)

Objetivo: evaluar el Desempeño de la Gestión Organizativa de los Servicios Hospitalarios en Brasil. Método: estudio transversal que utilizó datos del Programa Nacional de Evaluación de Servicios de Salud-PNASS 2015-2016 para evaluar el Desempeño de la Gestión Organizativa de 1665 hospitales en Brasil. Se utilizaron 30 elementos de verificación distribuidos en 5 criterios: Gestión de Contratos, Gestión de Personas, Gestión de la Información, Planificación y Organización, Modelo Organizativo, que compusieron una puntuación de evaluación...(AU)

Noncommunicable chronic diseases clusters in Brazilian adults and older adults: correlations as multimorbidity / Agrupamento de doenças crônicas não transmissíveis em adultos e idosos brasileiros: correlações como multimorbidade

Abstract Background Health has dynamic conditions and overlapping pathophysiological factors. For health prevention and promotion, actions are necessary to understand the most common risk combinations. Objective Describe noncommunicable chronic diseases (NCDs) clusters and investigate specific multimorbidity combinations in Brazilian adults and older adults. Method This study used data from Vigitel 2013 survey held in the Brazilian capitals (52,929 interviews). A self-report of diabetes, dyslipidemia, hypertension, and obesity was used. The analyses were the descriptive cluster of NCDs and an adjusted binary logistic regression (odds ratio [OR]), stratified by age. Results Among adults, the clusters of diabetes, dyslipidemia, hypertension, and obesity (O/E = 18.74) and diabetes, hypertension, and obesity (O/E = 16.83) were higher. There was a higher clustering between diabetes and obesity (O/E = 7.25). Among adults, diabetes was associated with dyslipidemia (OR: 3.04), hypertension (OR: 3.84), and hypertension with obesity (OR: 3.34). In older adults, hypertension was associated with diabetes (OR: 2.79), dyslipidemia (OR: 2.06), and obesity (OR: 2.26). Conclusion Other diseases combined with diabetes and hypertension were more frequent in adults and older adults. It is suggested to combine preventive and control measures for these diseases for the non-occurrence of new diagnoses.

Resumo Introdução A saúde apresenta condições dinâmicas e fatores fisiopatológicos sobrepostos. Para ações de prevenção e promoção da saúde é necessário entender as combinações comuns de risco. Objetivo Descrever os agrupamentos de doenças crônicas não transmissíveis (DCNT) e investigar combinações específicas de multimorbidade em adultos e idosos no Brasil. Método Este estudo utilizou dados da pesquisa Vigitel 2013, realizada nas capitais brasileiras (total de 52.929 entrevistas). Foi utilizado um relato de diabetes, dislipidemia, hipertensão e obesidade. Nas análises foram utilizados o agrupamento descritivo de DCNT e uma regressão logística binária ajustada (razão de odds [RO]), estratificada por idade. Resultados Entre os adultos, os grupos de diabetes, dislipidemia, hipertensão e obesidade (O / E = 18,74), bem como diabetes, hipertensão e obesidade (O / E = 16,83) foram maiores. Nos idosos, houve maior agrupamento entre diabetes e obesidade (O / E = 7,25). Entre os adultos, o diabetes foi associado à dislipidemia (RO: 3,04) e hipertensão (RO: 3,84), enquanto a hipertensão à obesidade (RO: 3,34). Nos idosos, a hipertensão foi associada a diabetes (RO: 2,79), dislipidemia (RO: 2,06) e obesidade (RO: 2,26). Conclusão Os agrupamentos de outras doenças combinadas com diabetes e hipertensão foram mais frequentes em adultos e idosos. Sugere-se que além das medidas existentes de prevenção para essas doenças também sejam propostas medidas de controle para a não ocorrência de novos diagnósticos.

Depression Screening in a population-based study: Brazilian National Health Survey 2019 / Rastreamento de sintomas depressivos em um estudo de base populacional: Pesquisa Nacional de Saúde 2019

Abstract This study evaluated the prevalence of positive screening for depression in Brazil and its associated factors. We used data from National Health Survey 2019 (Pesquisa Nacional de Saúde - PNS), a population-based survey with 88,531 adults. The Patient Health Questionnaire (PHQ-9) was used with two scoring methods, the algorithm and the cutoff point≥10. The variables included sociodemographic characteristics. The prevalence ratios and 95% confidence intervals (95%CI) were estimated using Poisson regression. The positive screening for depression was 10.8% (95%CI: 10.4-11.0), at the cutoff point ≥10 and 5.7% (95%CI: 5.4-6.0) for algorithm. Significant differences were found in prevalence in some Brazilian states. Multivariable analyses showed that being female, black, under 70 years of age, having little education, being single, and living in an urban area were independently associated with a depressive symptoms. The highest association was found in the states of Sergipe, Goiás, Piauí, Espírito Santo, São Paulo, Alagoas and lowest in Pará, Mato Grosso and Maranhão. The prevalence of positive screening for depression in Brazil has increased in recent years. More investment in mental health resources is necessary and surveys such as the PNS should be continued.

Resumo Este estudo avaliou a prevalência de triagem positiva para depressão no Brasil e seus fatores associados. Utilizou-se dados da Pesquisa Nacional de Saúde 2019 (PNS), um inquérito de base populacional com 88.531 adultos. Para avaliar os sintomas depressivos utilizou-se o Patient Health Questionnaire (PHQ-9) com dois métodos de pontuação: o algoritmo e o ponto de corte ≥10. As variáveis incluíram características sociodemográficas. Utilizou-se a regressão de Poisson para obter razões de prevalência, com intervalo de confiança de 95% (IC95%). A triagem positiva para depressão foi de 10,8% (IC95%: 10,4-11,0), no ponto de corte ≥10 e 5,7% (IC95%: 5,4-6,0) para o algoritmo. Houve diferenças significativas na prevalência entre alguns estados brasileiros. Análises multivariadas mostraram que ser do sexo feminino, negro, ter menos de 70 anos, ter baixa escolaridade, ser solteiro e residir em área urbana estiveram independentemente associados a sintomas depressivos. A maior associação foi encontrada nos estados de Sergipe, Goiás, Piauí, Espírito Santo, São Paulo, Alagoas e a menor no Pará, Mato Grosso e Maranhão. A prevalência de triagem positiva para depressão no Brasil tem aumentado nos últimos anos. É necessário mais investimento em saúde mental e pesquisas como a PNS devem ser feitas continuamente.