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

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

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

[Estimated multimorbity among young Brazilians: results of the 2019 National Health Survey]. / Estimativa de multimorbidade em jovens brasileiros: resultados da Pesquisa Nacional de Saúde 2019.

Multimorbidity, namely the presence of two or more chronic non-communicable diseases, is directly associated with behavioral factors. This study sought to estimate the prevalence of multimorbidity among young Brazilians by linking it to different social and lifestyle determinants. It involved a cross-sectional study of the data source, namely the 2019 National Health Survey. Data from individuals aged between 15 and 24 years (n = 10,460) were selected. Associated factors were investigated by calculating the Prevalence Ratio with robust variance, suitable for bivariate and multivariate analysis. The prevalence of multimorbidity in young people was estimated at 7.84% (95%CI: 7.01-8.75; N: 2,455,097). The most common conditions were mental illness, depression, asthma or bronchitis and chronic back problems. In the adjusted model, young females (PR: 1.84; 95%CI: 1.44-2.36), obese youths (PR: 1.97; 95%CI: 1.45-2.68) and former smokers (PR: 1.46; 95%CI: 1.12-1.90) showed a higher prevalence of multimorbidity. It was also revealed that the prevalence ratio for multimorbidity increased by 5% for each year of the individual's life. This study identified an association of multimorbidity with social determinants and lifestyle.

A multimorbidade, presença de duas ou mais doenças crônicas não transmissíveis, está diretamente associada a fatores comportamentais. O objetivo da pesquisa foi estimar a prevalência de multimorbidade em jovens brasileiros relacionando-a aos diferentes determinantes sociais e de estilo de vida. Trata-se de um estudo transversal cuja fonte de dados foi a Pesquisa Nacional de Saúde em 2019. Foram selecionados dados de indivíduos com idade entre 15 e 24 anos (n = 10.460). Os fatores associados foram investigados por meio do cálculo da razão de prevalência com variância robusta, adequado para análise bivariada e multivariada. A prevalência de multimorbidade nos jovens foi estimada em 7,84% (IC95%: 7,01-8,75; N: 2.455.097). Os agravos mais comuns foram doenças mentais, depressão, asma ou bronquite e problemas crônicos de coluna. No modelo ajustado, jovens do sexo feminino (RP: 1,84; IC95%: 1,44-2,36), obesos (RP: 1,97; IC95%: 1,45-2,68) e ex-fumantes (RP: 1,46; IC95%: 1,12-1,90) apresentaram maiores prevalências para multimorbidade. A razão de prevalência para multimorbidade aumentou 5% a cada ano de vida do indivíduo. Este estudo identificou uma associação de multimorbidade com determinantes sociais e estilo de vida.

Incidence and mortality by larynx cancer in Central and South America.

OBJECTIVE: To describe how the incidence and mortality trends for laryngeal cancer in South and Central American countries. METHODS: Time series study, with incidence data from the International Agency for Research on Cancer, from 1990 to 2012 and mortality data from 17 countries of the World Health Organization, from 1995 to 2013. The trend was analyzed by Joinpoint regression. RESULTS: The highest incidence rate for laryngeal cancer was in Brazil, with 5.9 new cases per 100,000 men, and the highest mortality rate in Uruguay with 4.2 deaths per 100,000 men. The incidence ratio between genders ranged from 4: 1 (Colombia) to 12: 1 (Ecuador). The mortality ratio between the sexes ranged from 4: 1 (Peru) to 14: 1 (Uruguay). CONCLUSION: Most countries had low incidence rates and reduced mortality in Latin America.

Gender and Regional Differences in Lung Cancer Mortality in Brazil.

BACKGROUND AND OBJECTIVE: This was a population-based ecological with data of deaths from the Mortality Information System. The objective of this study was to analyze the temporal trends of mortality induced by bronchi and lung cancer in Brazil and its geographical regions between 2001 and 2015 and secondly to calculate predictions for 2016-2030. MATERIAL AND METHODS: The mortality trends were analyzed by the Joinpoint regression and calculation of predictions was used the Nordpred software. RESULTS: There was a reduction trend in lung cancer mortality among Brazilian men living in South and Southeast regions of Brazil. However, there was an increasing trend in lung cancer mortality among Brazilian women living in Northeast, Southeast, and South regions of Brazil. When comparing the last observed period and the last foreseen period for males, it is expected an increase of 12.86% in the number of deaths, justified mainly by the change in population structure, with a reduction in the risk of death by the disease. For women, the expected increase is 26.22%, justified both by population structure, and the increased risk of deaths from the disease. The higher rates will be observed in the southern region of the country, for both sexes. CONCLUSION: The mortality induced by lung and bronchial cancer in Brazil was unevenly distributed. However lung cancer incidence had a reducing trend, the mortality caused following it was increased among men. For women, the rates are rising, and until 2030, the mortality load will continue to rise for both.
.

Association of cervical and breast cancer mortality with socioeconomic indicators and availability of health services.

OBJECTIVE: Analyze cervical and breast cancer mortality in Brazil and its relationship with socioeconomic population indicators and availability of health services in the period 2011-2015. METHODS: An ecological study is presented herein. Mortality data were extracted from the Mortality Information System, based on ICD-10, per area of residence and age group, for the period 2011-2015. Socioeconomic variables were extracted from the Brazilian Human Development Atlas, and the National Register of Health Facilities (CNES) provided data on the density of physicians and health services. Statistical analysis was carried out using the Chi-squared test and Poisson regression, with robust variance and 95 % confidence level. RESULTS: The median age-standardized mortality rates for cervical and breast cancers were, respectively, 5.95 (± 3.97) and 10.65 (± 3.12) per 100,000 women. High cervical cancer mortality rates presented a statistically significant association with GINI Index (p=0.000) and Human Development Index - HDI (p=0.030). High breast cancer mortality rates were positively associated with the variables "number of general physicians per 100,000 inhabitants" (p = 0.005) and "Number of licensed oncology centers per 1,000,000 inhabitants" (p = 0.002). CONCLUSION: The importance of organization and equity in the access to health services is highlighted herein, enabling the reorientation of public policies aimed at the minimization of health disparities.

Factors associated with poor access to health services in Brazil. / Fatores associados ao acesso precário aos serviços de saúde no Brasil.

OBJECTIVE: To analyze factors associated with poor access to health services among the Brazilian population aged 19 years or older. METHODS: This is a cross-sectional study based on data from the 2013 National Health Survey, obtained from a complex sample. The poor access outcome was defined as not having received care the last time the participant sought a health service and not seeking care again for lack of accessibility. We analyzed the prevalence of poor access and its association with socioeconomic and health factors by calculating prevalence ratios (PR) with 95% confidence intervals. We also used Poisson's multivariate regression model with the Wald test for robust estimation. RESULTS: Out of the 60,202 valid responses, 12,435 individuals met the criteria for poor access. Poor access had a prevalence of 18.1% (95%CI 16.8 - 19.4) and was associated with the following factors: being black/multiracial (PR = 1.2; 95%CI 1.0 - 1.4); living in the North (PR = 1.5; 1.3 - 1.9) and Northeast (PR = 1.4; 1.2 - 1.6) regions compared to the Southeast region; living in a rural area (PR = 1.2; 1.1 - 1.4); being a smoker (PR = 1.2; 1.0 - 1.4); having poor/very poor self-rated health (PR = 1.3; 1.1 - 1.6); not having private health insurance (PR = 2.3; 1.7 - 2.9). CONCLUSION: Access to health services is still precarious for a considerable part of the Brazilian population, especially the most vulnerable groups.

OBJETIVO: Analisar os fatores associados ao acesso precário aos serviços de saúde pela população brasileira de 19 anos ou mais. MÉTODOS: Trata-se de estudo transversal, com base nos dados da Pesquisa Nacional de Saúde, 2013, obtidos de uma amostragem complexa. O desfecho acesso precário foi definido como não ter conseguido atendimento na última vez que procurou e não ter tentado novo atendimento por falta de acessibilidade. Foi analisada a prevalência do acesso precário e sua associação com fatores socioeconômicos e de saúde, por meio do cálculo da razão de prevalências (RP) com intervalos de confiança de 95%. Aplicou-se, ainda, o modelo multivariado pela regressão de Poisson, com teste de Wald para estimação robusta. RESULTADOS: Das 60.202 respostas válidas, 12.435 indivíduos enquadraram-se nos critérios do acesso precário. A prevalência do acesso precário foi de 18,1% (IC95% 16,8 - 19,4) e associou-se com os seguintes fatores: ter cor da pele preta/parda (RP = 1,2; IC95% 1,0 - 1,4); residir na região Norte (RP = 1,5; 1,3 - 1,9) e Nordeste (RP = 1,4; 1,2 - 1,6) em relação à região Sudeste; viver na zona rural (RP = 1,2; 1,1 - 1,4); ser fumante (RP = 1,2; 1,0 - 1,4); ter autoavaliação de saúde ruim/muito ruim (RP = 1,3; 1,1 - 1,6); não ter plano de saúde privado (RP = 2,3; 1,7 - 2,9). CONCLUSÃO: O acesso aos serviços de saúde ainda é precário para uma parcela considerável da população brasileira, com destaque para a população mais vulnerável.

Prevalence of hearing impairment and associated factors in school-aged children and adolescents: a systematic review.

INTRODUCTION: Hearing impairment is one of the communication disorders of the 21st century, constituting a public health issue as it affects communication, academic success, and life quality of students. Most cases of hearing loss before 15 years of age are avoidable, and early detection can help prevent academic delays and minimize other consequences. OBJECTIVE: This study researched scientific literature for the prevalence of hearing impairment in school-aged children and adolescents, with its associated factors. This was accomplished by asking the defining question: "What is the prevalence of hearing impairment and its associated factors in school-aged children and adolescents?" METHODS: Research included the databases PubMed/MEDLINE, LILACS, Web of Science, Scopus and SciELO, and was carried out by two researchers, independently. The selected papers were analyzed on the basis of the checklist provided by the report Strengthening the Reporting of Observational Studies in Epidemiology. RESULTS: From the 463 papers analyzed, 26 fulfilled the criteria and were included in the review presented herein. The detection methods, as well as prevalence and associated factors, varied across studies. The prevalence reported by the studies varied between 0.88% and 46.70%. Otologic and non-otologic factors were associated with hearing impairment, such as middle ear and air passage infections, neo- and post-natal icterus, accumulation of cerumen, family history, suspicion of parents, use of earphones, age and income. CONCLUSION: There is heterogeneity regarding methodology, normality criteria, and prevalence and risk factors of studies about hearing loss in adolescents and school-aged children. Nevertheless, the relevance of the subject and the necessity of early interventions are unanimous across studies.

Survival analysis of patients with sepsis in Brazil.

INTRODUCTION: This study aimed to analyze the survival of septic patients and to assess prognostic factors. METHODS: Patients with sepsis, severe sepsis, and septic shock were followed up and clinical and laboratory data were collected. The sepsis-related organ failure assessment (SOFA) score was calculated. RESULTS: The overall 30-day survival rates of patients with sepsis, severe sepsis, and septic shock were 86.3%, 72.5%, and 20%, respectively. Mortality was related to old age, septic shock, coagulopathy, lactate level, and high SOFA score among other factors. CONCLUSIONS: Identification of prognostic variables may reduce sepsis-related mortality.

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

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

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

PANCREATIC CANCER IN BRAZIL: MORTALITY TRENDS AND PROJECTIONS UNTIL 2029.

BACKGROUND: Pancreatic cancer is one of the main cancer-related causes of death in developed countries, and one of the most lethal malignant neoplasms. This type of cancer is classified as the ninth most frequent in the world. OBJECTIVE: Analyze temporal trends for pancreatic cancer in Brazil in the period 2000-2014 and calculate mortality projections for the period 2015-2029. METHODS: Ecological study, with temporal series, based on information provided by the Brazilian Mortality Information System. Analysis included deaths due to pancreatic malignant neoplasms in Brazil in the period 2000-2014, and analyzed according to sex, age group and Brazilian geographic regions. Projections were made until 2029 in five-year periods, calculated in Nordpred (within the R software). Mortality trends were analyzed by Joinpoint regression. RESULTS: Between 2000 and 2014, there were 112,533 deaths due to pancreatic cancer in Brazil. Age-standardised rates was 5.1 deaths/100,000 men and 3.81 deaths/100,000 women. The highest rates were registered for the Midwest region, for both genders. Projections indicated that for the five-year period 2025-2029 there will be increased mortality rates for men in the Northeast and Midwest regions. Joinpoint analysis for Brazil did not reveal significant increases for women (APC=0.4%; 95% CI: -0.2; 1.0), however, there was a significant increasing mortality trend for men (APC= 3.7%; 95% CI: 0.6-7.0) in the period 2000-2004, followed by a stable period, an then another period of significant increases after 2010. These figures are mostly explained by variations in the Brazilian demographic structure. CONCLUSION: Pancreatic cancer mortality is unequally distributed across Brazilian regions and genders, and during the next two decades the differences will be accentuated.

Estimativa de multimorbidade em jovens brasileiros: resultados da Pesquisa Nacional de Saúde 2019 / Estimated multimorbity among young Brazilians: results of the 2019 National Health Survey

Resumo A multimorbidade, presença de duas ou mais doenças crônicas não transmissíveis, está diretamente associada a fatores comportamentais. O objetivo da pesquisa foi estimar a prevalência de multimorbidade em jovens brasileiros relacionando-a aos diferentes determinantes sociais e de estilo de vida. Trata-se de um estudo transversal cuja fonte de dados foi a Pesquisa Nacional de Saúde em 2019. Foram selecionados dados de indivíduos com idade entre 15 e 24 anos (n = 10.460). Os fatores associados foram investigados por meio do cálculo da razão de prevalência com variância robusta, adequado para análise bivariada e multivariada. A prevalência de multimorbidade nos jovens foi estimada em 7,84% (IC95%: 7,01-8,75; N: 2.455.097). Os agravos mais comuns foram doenças mentais, depressão, asma ou bronquite e problemas crônicos de coluna. No modelo ajustado, jovens do sexo feminino (RP: 1,84; IC95%: 1,44-2,36), obesos (RP: 1,97; IC95%: 1,45-2,68) e ex-fumantes (RP: 1,46; IC95%: 1,12-1,90) apresentaram maiores prevalências para multimorbidade. A razão de prevalência para multimorbidade aumentou 5% a cada ano de vida do indivíduo. Este estudo identificou uma associação de multimorbidade com determinantes sociais e estilo de vida.

Abstract Multimorbidity, namely the presence of two or more chronic non-communicable diseases, is directly associated with behavioral factors. This study sought to estimate the prevalence of multimorbidity among young Brazilians by linking it to different social and lifestyle determinants. It involved a cross-sectional study of the data source, namely the 2019 National Health Survey. Data from individuals aged between 15 and 24 years (n = 10,460) were selected. Associated factors were investigated by calculating the Prevalence Ratio with robust variance, suitable for bivariate and multivariate analysis. The prevalence of multimorbidity in young people was estimated at 7.84% (95%CI: 7.01-8.75; N: 2,455,097). The most common conditions were mental illness, depression, asthma or bronchitis and chronic back problems. In the adjusted model, young females (PR: 1.84; 95%CI: 1.44-2.36), obese youths (PR: 1.97; 95%CI: 1.45-2.68) and former smokers (PR: 1.46; 95%CI: 1.12-1.90) showed a higher prevalence of multimorbidity. It was also revealed that the prevalence ratio for multimorbidity increased by 5% for each year of the individual's life. This study identified an association of multimorbidity with social determinants and lifestyle.

Frequência da deficiência auditiva relacionada às infecções congênitas: estudo transversal retrospectivo / Frequency of hearing loss related to congenital infections: retrospective cross-sectional study / Frecuencia de hipoacusia relacionada con infecciones congénitas: un estúdio transversal retrospectivo

Introdução: As infecções congênitas durante a gravidez são indicadores de risco para a deficiência auditiva. Objetivo: Verificar a frequência da deficiência auditiva nas crianças atendidas num serviço público com indicadores de risco de infecções congênitas. Métodos: Trata-se de um estudo transversal retrospectivo. A população do estudo foi de crianças de 0 a 3 anos atendidas no período de 2011 a 2019. Foi realizada consulta e análise no banco de dados da Instituição extraindo informações das crianças quanto à presença de infecção congênita relatada (citomegalovírus, herpes, rubéola, sífilis, toxoplasmose, HIV e Zika vírus) e o diagnóstico audiológico completo. A amostra deste estudo foi constituída por 558 crianças e foram analisadas a presença de coocorrência entre as infecções ou de outros indicadores de risco para a deficiência auditiva. Realizou-se análise descritiva para estabelecer a frequência da deficiência auditiva em relação a cada infecção congênita isolada ou associada a outros indicadores de risco. Resultados: 14,40% das crianças apresentavam o relato de infecção congênita isolada ou em combinação com outro IRDA. A frequência da deficiência auditiva foi de 1,25%, com a presença da perda auditiva sensorioneural em seis crianças (85,71%) e uma perda auditiva do tipo condutiva (14,29%), das quais seis foram bilaterais (85,71%) e uma unilateral (14,29%). Esta frequência de deficiência auditiva foi relacionada ao histórico de citomegalovírus (57,14%), seguido de toxoplasmose (28,57%) e rubéola com Zika vírus (14,29%). Conclusão: A frequência do diagnóstico de deficiência auditiva foi de 1,25% nas crianças com relato de infecções congênitas. (AU)

Introduction: Congenital infections during pregnancy are risk indicators for hearing loss. Purpose: To verify the frequency of hearing loss in children attended at the public service with risk indicators for congenital infections. Methods: This is a retrospective cross-sectional study. The population consisted of children aged 0 to 3 years attended in the period from 2011 to 2019. Consultation and analysis were carried out in the Institution's database, extracting information from the children regarding the presence of reported congenital infection (cytomegalovirus, herpes, rubella, syphilis, toxoplasmosis, HIV and Zika virus) and the complete audiological diagnosis. The sample of this study consisted of 558 children and the presence of co-occurrence between infections or other risk indicators for hearing loss was analyzed. Descriptive analysis was performed to establish the frequency of hearing loss in relation to each congenital infection isolated or associated with other risk indicators. Results: 14.40% of the children had a report of isolated congenital infection or in combination with another risk indicator. The frequency of hearing loss was 1.25%, with sensorineural hearing loss in six children (85.71%) and a conductive hearing loss (14.29%), of which six were bilateral (85, 71%) and one unilateral (14.29%). This frequency of hearing loss was related to the history of cytomegalovirus (57.14%), followed by toxoplasmosis (28.57%) and rubella with zika virus (14.29%). Conclusion: The frequency of diagnosis of hearing loss was 1.25% in children with reports of congenital infections. (AU)

Introducción: Las infecciones congénitas durante el embarazo son indicadores de riesgo de hipoacusia. Propósito: Verificar la frecuencia de hipoacusia en niños atendidos en el servicio público con indicadores de riesgo de infecciones congénitas. Métodos: Se trata de un estudio transversal retrospectivo. La población de estudio estuvo constituida por los niños de 0 a 3 años atendidos en el periodo de 2011 a 2019. Se realizó consulta y análisis en la base de datos de la Institución, extrayéndose información de los niños en cuanto a la presencia de infección congénita reportada (citomegalovirus, herpes, rubéola, sífilis, toxoplasmosis, VIH y virus Zika) y el diagnóstico audiológico completo. La muestra de este estudio estuvo constituida por 558 niños y se analizó la presencia de coocurrencia entre infecciones u otros indicadores de riesgo de hipoacusia. Se realizó un análisis descriptivo para establecer la frecuencia de hipoacusia con relación a cada infección congénita aislada o asociada a otros indicadores de riesgo. Resultados: El 14,40% de los niños tenían reporte de infección congénita aislada o en combinación con otro indicador de riesgo. La frecuencia de hipoacusia fue del 1,25%, con hipoacusia neurosensorial en seis niños (85,71%) y hipoacusia conductiva (14,29%), de los cuales seis fueron bilaterales (85,71%) y uno unilateral (14,29%). Esta frecuencia de hipoacusia se relacionó con el antecedente de citomegalovirus (57,14%), seguido de toxoplasmosis (28,57%) y rubéola con virus zika (14,29%). Conclusión: La frecuencia de diagnóstico de hipoacusia fue de 1,25% en niños con reporte de infecciones congénitas. (AU)

Prevalence of multimorbidity in the Brazilian adult population according to socioeconomic and demographic characteristics.

Knowledge on the occurrence of multimorbidity is important from the viewpoint of public policies, as this condition increases the consumption of medicines as well as the utilization and expenses of health services, affecting life quality of the population. The objective of this study was to estimate prevalence of self-reported multimorbidity in Brazilian adults (≥18 years old) according to socioeconomic and demographic characteristics. A descriptive study is presented herein, based on data from the National Health Survey, which was a household-based survey carried out in Brazil in 2013. Data on 60,202 adult participants over the age of 18 were included. Prevalences and its respective confidence intervals (95%) were estimated according to sex, age, education level, marital status, self-reported skin color, area of residence, occupation and federative units (states). Poisson regression models univariate and multivariate were used to evaluate the association between socioeconomic and demographic variables with multimorbidity. To observe the combinations of chronic conditions the most common groups in pairs, trios, quartets and quintets of chronic diseases were observed. The prevalence of multimorbidity was 23.6% and was higher among women, in individuals over 60 years of age, people with low educational levels, people living with partner, in urban areas and among unemployed persons. The states of the South and Southeast regions presented higher prevalence. The most common groups of chronic diseases were metabolic and musculoskeletal diseases. The results demonstrated high prevalence of multimorbidity in Brazil. The study also revealed that a considerable share of the economically active population presented two or more chronic diseases. Data of this research indicated that socioeconomic and demographic aspects must be considered during the planning of health services and development of prevention and treatment strategies for chronic diseases, and consequently, multimorbidity.

HYPERVASCULAR LIVER LESIONS IN RADIOLOGICALLY NORMAL LIVER.

Background: The hypervascular liver lesions represent a diagnostic challenge. Aim: To identify risk factors for cancer in patients with non-hemangiomatous hypervascular hepatic lesions in radiologically normal liver. Method: This prospective study included patients with hypervascular liver lesions in radiologically normal liver. The diagnosis was made by biopsy or was presumed on the basis of radiologic stability in follow-up period of one year. Cirrhosis or patients with typical imaging characteristics of haemangioma were excluded. Results: Eighty-eight patients were included. The average age was 42.4. The lesions were unique and were between 2-5 cm in size in most cases. Liver biopsy was performed in approximately 1/3 of cases. The lesions were benign or most likely benign in 81.8%, while cancer was diagnosed in 12.5% of cases. Univariate analysis showed that age >45 years (p< 0.001), personal history of cancer (p=0.020), presence of >3 nodules (p=0.003) and elevated alkaline phosphatase (p=0.013) were significant risk factors for cancer. Conclusion: It is safe to observe hypervascular liver lesions in normal liver in patients up to 45 years, normal alanine aminotransaminase, up to three nodules and no personal history of cancer. Lesion biopsies are safe in patients with atypical lesions and define the treatment to be established for most of these patients.

Racional: As lesões hepáticas hipervasculares representam um desafio diagnóstico. Objetivo: Identificar fatores de risco para câncer em pacientes portadores de lesão hepática hipervascular não-hemangiomatosa em fígado radiologicamente normal. Método: Estudo prospectivo que incluiu pacientes com lesões hepáticas hipervasculares em que o diagnóstico final foi obtido por exame anatomopatológico ou, presumido a partir de seguimento mínimo de um ano. Diagnóstico prévio de cirrose ou radiológico de hemangioma foram considerados critérios de exclusão. Resultados: Oitenta e oito pacientes foram incluídos. A relação mulher/homem foi de 5,3/1. A idade média foi de 42,4 anos. Na maior parte das vezes as lesões hepáticas foram únicas e com tamanho entre 2-5 cm. Em aproximadamente 1/3 dos casos foi realizada biópsia hepática. Em 81,8% dos casos as lesões eram benignas ou provavelmente benignas enquanto que em 12,5% dos casos o diagnóstico foi de câncer. A análise univariada mostrou que idade superior a 45 anos (p<0,001), antecedente familiar pessoal de câncer (p=0,020), presença de mais de três nódulos (p=0,003) e elevação da alanina aminotransaminase (p=0,013) foram fatores de risco relevantes para o câncer. Conclusões: È indicado observar lesões hepáticas hipervasculares em fígado normal em pacientes com até 45 anos, alanina aminotransaminase normal, com até três nódulos e sem antecedente pessoal de câncer. Para os demais com lesões atípicas, a biópsia da lesão é segura e define na maior parte dos pacientes o tratamento a ser instituído.

[Regional inequalities in cervical cancer mortality in Brazil: trends and projections through to 2030]. / Desigualdades regionais na mortalidade por câncer de colo de útero no Brasil: tendências e projeções até o ano 2030.

The scope of this article is to analyze the temporal trends of cervical cancer mortality in Brazil and calculate the projection of mortality through to the year 2030. Deaths that occurred within the 1996-2010 period were analyzed (Mortality Information System). Mortality trend analysis utilized the Joinpoint regression, while Nordpred was utilized for the calculation of projections. For Brazil, decreasing trends were identified (APC = 1.7% CI95%-2.2; -1.1 p < 0.05). The Midwest region presented a significant reduction trend (APC = -1.3% per year), along with the Southeast (APC = -3.3%) and South (APC = -3.9%) regions. The North and Northeast regions presented stable trends. The states of Acre (APC = -6.5%) and Rio Grande do Sul (APC = -4.1%) presented the most pronounced reduction trends. Analysis of the mortality projections revealed a reduction in mortality rates, starting from the first projected period, with a considerable reduction for the South region. Mortality rates through to the year 2030 are explained, principally, by reductions in the risk of the disease. Cervical cancer mortality presents reducing trends, however these are unequally distributed throughout the country, where the North and Northeast regions present the highest mortality rates.

MICROBIOLOGICAL ANALYSIS OF BILE IN PATIENTS WITH BENIGN AND MALIGNANT BILIOPANCREATIC DISEASES AND ITS CONSEQUENCES.

BACKGROUND: Bactibilia has several consequences to human health. OBJETIVE: Assessing the bile microbiology of patients with biliopancreatic diseases in order to identify bacteria and their possible infectious complications. METHODS: Retrospective study of 30 bile culture samples from patients with benign and malignant biliopancreatic diseases. The samples were assessed to set the bile microbiological flora and to search for its possible link with comorbidity, carcinogenesis and postoperative infectious complications. RESULTS: Thirty bile samples from patients at mean age ≈57.7 years, mostly female (n=18), were assessed. Bactibilia was found in 12 cases, mostly in patients with benign diseases (n=8), older than 50 years (n=23) and female (n=10). Adenocarcinoma of the duodenal papilla (n=9) and cholelithiasis (n=8) were the most common diseases. Escherichia coli (n=5) and Klebsiella sp (n=3) were predominantly found in patients with benign diseases; and Klebsiella sp (n=2) and Streptococcus sp (n=2) were prevalent in cancer patients. There were postoperative infectious complications in seven cases, five of them in bactibilia-associated patients (P=0.084). CONCLUSION: Bactibilia was found in 12 samples and Escherichia coli and Klebsiella sp were most often identified in patients with benign diseases, as well as Streptococcus sp and Klebsiella sp in cancer patients. There was a trend of higher postoperative infectious complication incidence in patients with bactibilia.

Fatores associados ao acesso precário aos serviços de saúde no Brasil / Factors associated with poor access to health services in Brazil

RESUMO: Objetivo: Analisar os fatores associados ao acesso precário aos serviços de saúde pela população brasileira de 19 anos ou mais. Métodos: Trata-se de estudo transversal, com base nos dados da Pesquisa Nacional de Saúde, 2013, obtidos de uma amostragem complexa. O desfecho acesso precário foi definido como não ter conseguido atendimento na última vez que procurou e não ter tentado novo atendimento por falta de acessibilidade. Foi analisada a prevalência do acesso precário e sua associação com fatores socioeconômicos e de saúde, por meio do cálculo da razão de prevalências (RP) com intervalos de confiança de 95%. Aplicou-se, ainda, o modelo multivariado pela regressão de Poisson, com teste de Wald para estimação robusta. Resultados: Das 60.202 respostas válidas, 12.435 indivíduos enquadraram-se nos critérios do acesso precário. A prevalência do acesso precário foi de 18,1% (IC95% 16,8 - 19,4) e associou-se com os seguintes fatores: ter cor da pele preta/parda (RP = 1,2; IC95% 1,0 - 1,4); residir na região Norte (RP = 1,5; 1,3 - 1,9) e Nordeste (RP = 1,4; 1,2 - 1,6) em relação à região Sudeste; viver na zona rural (RP = 1,2; 1,1 - 1,4); ser fumante (RP = 1,2; 1,0 - 1,4); ter autoavaliação de saúde ruim/muito ruim (RP = 1,3; 1,1 - 1,6); não ter plano de saúde privado (RP = 2,3; 1,7 - 2,9). Conclusão: O acesso aos serviços de saúde ainda é precário para uma parcela considerável da população brasileira, com destaque para a população mais vulnerável.

ABSTRACT: Objective: To analyze factors associated with poor access to health services among the Brazilian population aged 19 years or older. Methods: This is a cross-sectional study based on data from the 2013 National Health Survey, obtained from a complex sample. The poor access outcome was defined as not having received care the last time the participant sought a health service and not seeking care again for lack of accessibility. We analyzed the prevalence of poor access and its association with socioeconomic and health factors by calculating prevalence ratios (PR) with 95% confidence intervals. We also used Poisson's multivariate regression model with the Wald test for robust estimation. Results: Out of the 60,202 valid responses, 12,435 individuals met the criteria for poor access. Poor access had a prevalence of 18.1% (95%CI 16.8 - 19.4) and was associated with the following factors: being black/multiracial (PR = 1.2; 95%CI 1.0 - 1.4); living in the North (PR = 1.5; 1.3 - 1.9) and Northeast (PR = 1.4; 1.2 - 1.6) regions compared to the Southeast region; living in a rural area (PR = 1.2; 1.1 - 1.4); being a smoker (PR = 1.2; 1.0 - 1.4); having poor/very poor self-rated health (PR = 1.3; 1.1 - 1.6); not having private health insurance (PR = 2.3; 1.7 - 2.9). Conclusion: Access to health services is still precarious for a considerable part of the Brazilian population, especially the most vulnerable groups.

Absenteísmo entre trabalhadores do sistema único de saúde: uma revisão sistemática / Absenteeism among workers in the Unified Health System: a systematic review / Ausentismo de los trabajadores en el Sistema Único de Salud: una revisión sistemática

Introdução:Os avanços da sociedade moderna trouxeram grandes desafios aos mais variados setores do mercado de trabalho,levandoosindivíduosa se readaptaremaos novos processos de trabalho.Um dos desafios remete a extensas jornadas e múltiplos vínculos empregatícios, fato que aumenta a vulnerabilidade, as chances de adoecimento e absenteísmo dos trabalhadores. Objetivo:Conhecer aprevalência do absenteísmo entre os trabalhadores do Sistema Único de Saúde, assim como os profissionais mais acometidos, a causa mais prevalente e o tempo médio de afastamento.Metodologia:Trata-se de uma revisão sistemáticada literaturaguiada pelo protocolo PRISMA. As evidências, publicadas até 31 de dezembro de 2019,foram recuperadas das bases WEB OF SCIENCE, WHOLIS, PAHO, SCOPUS, SCIELOe PUBMED/MEDLINEe a avaliação da qualidade dos estudos foi conduzida por uma versão adaptada do protocolo STROBE.Resultados:Os achados dos 17 artigos incluídos nesta revisão revelamque a frequência de absenteísmo, assim como o tempo médio de afastamento entre os trabalhadores do Sistema Único de Saúde, é variável. Os estudos selecionados apontam os profissionais de enfermagem como a categoria que mais se ausenta do trabalho. Entretanto, ao considerar esse achado, precisa-se destacar que a quantidade de estudos encontrados para as demais categorias profissionais é limitada. Conclusões:As consequências do absenteísmo não recaem apenas sobre o trabalhador ou sobre o empregador, mas geram sobrecarga aos profissionais não faltosos, fato que compromete a qualidade da atenção aos usuários do Sistema Único de Saúde. Destaca-se que o conhecimento acerca do absenteísmo podeser um importante instrumento para a gestão do trabalho em saúde (AU).

Introduction:The advances of modern society have brought great challenges to the most varied sectors of the labor market, leading individuals to readapt to the new work processes. One of the challenges refers to long hours and multiple employmentbonds, a fact that increases the vulnerability, the chances of illness and absenteeism of workers.Objective:To know the prevalence of absenteeism among workers in the Unified Health System, as well as the most affected professionals, the most prevalent cause and the average time away from work.Methodology:This is a systematic review of the literature guided by the PRISMA protocol. The evidence, published until December 31, 2019, was retrieved from the WEB OF SCIENCE, WHOLIS, PAHO, SCOPUS, SCIELO and PUBMED/MEDLINE databases and the evaluation of the quality of the studies was conducted by an adapted version of the STROBE protocol.Results:The findings of the 17 articles included in this review reveal that the frequency of absenteeism, as well as the average time of absence between workers in the Unified Health System, is variable. The selected studies point to nursing professionals as the category that is most absent from work. However, when considering this finding, it should be noted that the number of studies found for theother professional categories is limited.Conclusions:The consequences of absenteeism do not fall only on the worker or the employer, but they create a burden on non-absent professionals, a fact that compromises the quality of care for users of the Unified Health System. It is highlighted that knowledge about absenteeism can be a important tool for the management of health work (AU).

Introducción: Los avances de la sociedad moderna han traído grandes retos a los más variados sectores del mercado laboral, llevando a las personas a readaptarse a los nuevos procesos laborales. Uno de los desafíos se refiere a las largas jornadas ylas múltiples relaciones laborales, hecho que aumenta la vulnerabilidad, las posibilidades de enfermedad y el absentismo de los trabajadores. Objetivo: Conocer la prevalencia de absentismo entre los trabajadores del Sistema Único de Salud, así como los profesionales más afectados, la causa más prevalente y el tiempo medio de baja laboral. Metodología: Se trata de una revisión sistemática de la literatura guiada por el protocolo PRISMA. La evidencia, publicada hasta el 31 de diciembre de 2019, se recuperó de las bases de datos WEB OF SCIENCE, WHOLIS, PAHO, SCOPUS, SCIELOy PUBMED/MEDLINE y la evaluación de la calidad de los estudios se realizó mediante una versión adaptada del protocolo STROBE. Resultados: Los hallazgos de los 17 artículos incluidos en esta revisión revelan que la frecuencia de absentismo, así como el tiempo medio de ausencia entre los trabajadores del Sistema Único de Salud, es variable. Los estudios seleccionados señalan a los profesionales de enfermería como la categoría más ausente del trabajo. Sin embargo, al considerar este hallazgo, debe tenerse en cuenta que el número de estudios encontrados para las otras categorías profesionales es limitado.Conclusiones: Las consecuencias del absentismo no recaen solo sobre el trabajador o el empleador, sino que generan una carga para los profesionales no ausentes, hecho que compromete la calidad de la atención a los usuarios del Sistema Único de Salud. Se destaca que el conocimiento sobre el absentismo puede ser unaherramienta importante para la gestión del trabajo sanitario (AU).

Incidence and mortality by larynx cancer in Central and South America / Incidencia y mortalidad por cáncer de laringe en Centro y Sudamérica / Incidência e mortalidade por câncer de laringe na América Central e do Sul

ABSTRACT Objective: To describe how the incidence and mortality trends for laryngeal cancer in South and Central American countries. Methods: Time series study, with incidence data from the International Agency for Research on Cancer, from 1990 to 2012 and mortality data from 17 countries of the World Health Organization, from 1995 to 2013. The trend was analyzed by Joinpoint regression. Results: The highest incidence rate for laryngeal cancer was in Brazil, with 5.9 new cases per 100,000 men, and the highest mortality rate in Uruguay with 4.2 deaths per 100,000 men. The incidence ratio between genders ranged from 4: 1 (Colombia) to 12: 1 (Ecuador). The mortality ratio between the sexes ranged from 4: 1 (Peru) to 14: 1 (Uruguay). Conclusion: Most countries had low incidence rates and reduced mortality in Latin America.

RESUMEN Objetivo: Describir cómo tendencias de incidencia y mortalidad por cáncer de laringe en países de América del Sur y Central. Métodos: Estudio de series temporales, con datos de incidencia de Agencia Internacional de Investigación sobre el Cáncer, de 1990 a 2012 y datos de mortalidad de 17 países de Organización Mundial de Salud, de 1995 a 2013. La tendencia se analizó mediante regresión de Joinpoint. Resultados: La tasa de incidencia más alta para el cáncer de laringe fue en Brasil, con 5.9 casos nuevos por cada 100,000 hombres, y tasa de mortalidad más alta en Uruguay con 4.2 muertes por cada 100,000 hombres. La razón de incidencia entre géneros varió de 4: 1 (Colombia) a 12: 1 (Ecuador). La razón de mortalidad entre los sexos varió de 4: 1 (Perú) a 14: 1 (Uruguay). Conclusión: La mayoría de países tenían tasas de incidencia bajas y mortalidad reducida en América Latina.

RESUMO Objetivo: Descrever as tendências da incidência e mortalidade para o câncer de laringe em países da América do sul e central. Métodos: Estudo de série temporal, com dados de incidência da Agência Internacional para Pesquisa do Câncer, no período de 1990-2012 e dados de mortalidade de 17 países da Organização Mundial da Saúde, no período de 1995-2013. A tendência foi analisada pela regressão Joinpoint. Resultados: A taxa de incidência mais elevada para o câncer de laringe foi no Brasil, com 5,9 casos novos por 100.000 homens, e a taxa de mortalidade mais elevada foi no Uruguai com 4,2 óbitos por 100.000 homens. A razão de incidência entre os sexos variou de 4:1 (Colômbia) até 12:1 (Equador). A razão de mortalidade entre os sexos variou de 4:1 (Peru) a 14:1 (Uruguai). Conclusão: A maioria dos países apresentou baixas taxas de incidência e redução de mortalidade na América Latina.