Monitoring the goals of the plans for coping with Chronic Non-Communicable Diseases: results of the National Health Survey, Brazil, 2013 and 2019. / Monitoramento das metas dos planos de enfrentamento das Doenças Crônicas Não Transmissíveis: resultados da Pesquisa Nacional de Saúde, 2013 e 2019.

OBJECTIVE: To monitor the achievement of the action plans for the prevention and control of Non-Communicable Diseases agreed-upon targets. METHODS: Cross-sectional study, with data from the 2013 and 2019 National Health Survey. The following targets, up to 2025, were evaluated: physical inactivity, alcohol consumption, salt/sodium, tobacco use, high blood pressure, diabetes, overweight, obesity, cervical cytology testing, and drug therapy and counseling. To check whether the targets were achieved, the prevalence ratio was calculated (PR). RESULTS: 60,202 individuals were assessed in 2013, and 88,531 in 2019. The targets for physical inactivity (PR = 0.88; 95%CI 0.86;0.90) and cervical cytology coverage (79.4%; 95%CI 78.3;80.3) were achieved. Tobacco use was reduced, albeit below the target. The prevalence of hypertension, diabetes, overweight, obesity and alcohol consumption increased, and the targets will not be attained. CONCLUSION: Two indicators reached the agreed targets, however it is necessary to advance in actions and policies to meet the others.

Evaluation of community physical activity programs in Brazil: a scoping review. / Avaliação de programas comunitários de atividade física no Brasil: uma revisão de escopo.

Community physical activity programs were created to encourage and increase the practice of physical activity in the Brazilian population and promote healthy life habits. The Brazilian Ministry of Health invested in the evaluation of these programs and consolidated partnerships that favor the development of relevant evidence on the topic. The current study aimed to identify and summarize the scientific highlights on the approaches and results of evaluations performed in the Health Academy Program and City Academy Program. This is a scoping review based on the methodology of the Joanna Briggs Institute. We used the MEDLINE via PubMed, LILACS, Scopus, and Cochrane databases, the website of the Health Academy Program, the Catalogue of Theses and Dissertations of the Brazilian Graduate Studies Coordinating Board, and the Brazilian Digital Library of Theses and Dissertations. The sample included quantitative or qualitative primary studies with no limit on year of publication. Twenty-four studies published from 2009 to 2020 were selected and subdivided according to the approaches to evaluation: evaluability, sustainability, process (supply and structure), outcome (impact and satisfaction), and degree of inference (adequacy, plausibility, and probability). The results of the evaluations showed that the programs offer various activities, positively impact users' health indicators, and contribute to the increase in leisure-time physical activity. The evaluation of these programs is essential for the administration, health services, and healthcare workers, since it allows verifying the implementation of the proposed activities, coverage, access, impact, and interference by the political context in their continuity.

Os programas comunitários de atividade física foram criados para incentivar e aumentar esta atividade na população brasileira e promover hábitos de vida saudável. O Ministério da Saúde investiu na avaliação desses programas e consolidou parcerias que favoreceram a construção de importantes marcos sobre o tema. Este estudo objetivou identificar e sintetizar as evidências científicas sobre as abordagens e resultados das avaliações realizadas no Programa Academia da Saúde e Programa Academia da Cidade. Trata-se de uma revisão de escopo baseada na metodologia do Instituto Joanna Briggs. Utilizaram-se as bases MEDLINE via PubMed, LILACS, Scopus e Cochrane, o site do Programa Academia da Saúde, o Catálogo de Teses e Dissertações da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior e a Biblioteca Digital Brasileira de Teses e Dissertações. Incluíram-se estudos primários quantitativos ou qualitativos, sem limite temporal. Selecionaram-se 24 publicações entre 2009 e 2020, que foram subdivididas de acordo com as abordagens da avaliação: avaliabilidade, sustentabilidade, processo (oferta e estrutura), resultado (impacto e satisfação) e grau de inferência (adequação, plausibilidade e probabilidade). Os resultados das avaliações mostraram que os programas oferecem diversas atividades, impactam positivamente nos indicadores de saúde dos usuários e contribuem para o aumento de atividade física no lazer. A avaliação desses programas é fundamental para a gestão, serviços de saúde e profissionais, pois permite verificar a implementação das ações propostas, a cobertura, o acesso e o impacto, bem como a interferência do contexto político na sua continuidade.

Los programas comunitarios de actividad física fueron creados para incentivar y aumentar la práctica de actividad física en la población brasileña y promover hábitos de vida saludable. El Ministerio de Salud de Brasil invirtió en la evaluación de estos programas y consolidó colaboraciones que favorecieron la construcción de importantes evidencias sobre este asunto. Este estudio tuvo el objetivo de identificar y sintetizar las evidencias científicas sobre los abordajes y resultados de las evaluaciones realizadas en el Programa Academia de la Salud y Programa Academia de la Ciudad. Se trata de una revisión de alcance, basada en la metodología del Instituto Joanna Briggs. Se utilizaron las bases MEDLINE a través de PubMed, LILACS, Scopus y Cochrane, el sitio web del Programa Academia de la Salud, el Catálogo de Tesis y Disertaciones de la Coordinación de Perfeccionamiento de Personal de Nivel Superior y en la Biblioteca Digital Brasileña de Tesis y Disertaciones. Se incluyeron estudios primarios cuantitativos o cualitativos, sin límite temporal. Se seleccionaron 24 publicaciones entre 2009 y 2020. Se subdividieron de acuerdo con los abordajes de evaluación: disponibilidad, sostenibilidad, proceso (oferta y estructura), resultado (impacto y satisfacción) y grado de inferencia (adecuación, plausibilidad y probabilidad). Los resultados de las evaluaciones mostraron que los programas ofrecen diversas actividades, impactan positivamente en los indicadores de salud de los usuarios y contribuyen al aumento de actividad física en el ocio. La evaluación de estos programas es fundamental para la gestión, servicios de salud y profesionales, puesto que permite verificar la implementación de las acciones propuestas, la cobertura, el acceso y el impacto, así como la interferencia del contexto político en su continuidad.

Monitoring and projection of targets for risk and protection factors for coping with noncommunicable diseases in Brazilian capitals. / Monitoramento e projeções das metas de fatores de risco e proteção para o enfrentamento das doenças crônicas não transmissíveis nas capitais brasileiras.

This study aimed to monitor the trends and projections of targets of risk and protection factors for coping with noncommunicable diseases in Brazilian capitals and verify whether the economic crisis and austerity policies have interfered with these targets' behavior. This is a time-series study with data from the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey. We analyzed the trends in the prevalence of tobacco use, obesity, physical activity, consumption of fruits and vegetables, and alcohol abuse, and their projections until 2025. The Prais-Winsten regression was employed. We adopted the Interrupted Time-Series, considering the 2006-2014 and 2015-2019 periods. A reduction in tobacco use, increase in obesity, consumption of fruits and vegetables, physical activity, and alcohol use was observed between 2006 and 2014. Most indicators have shown worse performance since 2015. Projections foresee that targets for curbing obesity and alcohol abuse will not be achieved. Some changes were identified in the indicators profiles, reinforcing the importance of the continuous monitoring and sustainability of actions, policies, and programs to promote health and control these diseases and their risk factors.

Monitorar as tendências e as projeções das metas de fatores de risco e proteção para o enfrentamento das doenças crônicas não transmissíveis nas capitais brasileiras e verificar se a crise econômica e as políticas de austeridade interferiram no comportamento dessas metas. Estudo de série temporal com dados do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico. Foram analisadas as tendências das prevalências de fumantes, obesidade, prática de atividade física, consumo de frutas e hortaliças e de bebidas alcoólicas, e suas projeções até 2025. Empregou-se a regressão de Prais-Winsten. Utilizou-se a Série Temporal Interrompida de 2006 a 2014 e 2015 a 2019. Entre 2006 e 2014, houve redução de fumantes e aumento da obesidade, do consumo de frutas e hortaliças, de atividade física e do uso de álcool. A maioria dos indicadores demonstrou pior desempenho a partir de 2015. Pelas projeções, as metas de deter a obesidade e reduzir o uso de álcool não seriam atingidas. Houve mudanças no comportamento dos indicadores, o que reforça a importância do monitoramento contínuo, e da sustentabilidade das ações, políticas e programas de promoção a saúde e de controle dessas doenças e seus fatores de risco.

Socioeconomic inequalities related to noncommunicable diseases and their limitations: National Health Survey, 2019.

OBJECTIVE: to analyze socioeconomic inequalities in the self-reported prevalence of NonCommunicable Diseases (NCDs) and their disabilities in the Brazilian adult population. METHODS: Cross-sectional study with data from the National Health Survey carried out in 2019. The self-reported prevalences of individuals with some noncommunicable diseases were calculated, according to sociodemographic characteristics; and the prevalence and prevalence ratio of these diseases and degrees of disability, according to education and possession of a private health plan. RESULTS: 47.6% of the population reported having at least one noncommunicable diseases. Noncommunicable diseases increased progressively with age and were more prevalent in women (PR 1.13; 95%CI 1.1-1.15), in black (PR 1.04; 95%CI 1.01-1, 06) or brown individuals (PR 1.05; 95%CI 1.01-1.09), illiterate or with incomplete elementary education (PR 1.12; 95%CI 1.08-1.16), in the Southeast (PR 1.10; 95%CI 1.05-1.14) and the South (PR 1.07; 95%CI 1.03-1.12) and among individuals who do not have private health insurance (PR 1.02; 95%CI 1.0-1.05). For the majority of noncommunicable diseases investigated, the highest reports of disabilities were among those with low education and without health insurance. CONCLUSION: adults with less education and without private health plans have a higher prevalence of noncommunicable diseases and a higher degree of disability. Thus, it is important to analyze health indicators in the face of different populations and disparities, in order to understand and monitor health inequalities.

Convergence in alcohol abuse in Brazilian capitals between genders, 2006 to 2019: what population surveys show.

OBJECTIVE: To analyze the temporal trend of the prevalence of alcohol abuse among adults in Brazilian capitals, between 2006 and 2019. METHODS: Time series study, based on data from the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel), between 2006 and 2019. The population consisted of adults (≥ 18 years old) with landline telephone residing in Brazilian capitals. The trend analysis was performed by linear regression. RESULTS: Between 2006 and 2019 there was a significant increase (p = 0.03) in the abusive consumption of alcoholic beverages in the total adult population, from 15.6 to 18.8%. Among men, there was a stability trend (p = 0.96), and among women, there was an increase from 7.7 to 13.3% (p < 0.001; ß = 0.295). In the male gender stratified by capitals, from 2006 to 2019 there was a reduction in Belém, Fortaleza, João Pessoa, Macapá, Manaus, Natal, Recife, São Luis, and Teresina. On the other hand, there was growth in the Federal District. Among women, the trend was upward in: Aracaju, Belo Horizonte, Cuiabá, Curitiba, Florianópolis, Goiânia, Palmas, Porto Alegre, Rio de Janeiro, Salvador, São Paulo, Vitória, and the Federal District. CONCLUSION: The results indicate that more adult women are currently drinking in excess compared to previous years, suggesting an increased risk of alcohol-related harm in this portion of the population in Brazilian capitals, bringing about a convergence effect with the prevalence among men and women.

Use of health services and adherence to social distancing by adults with Noncommunicable Diseases during the COVID-19 pandemic, Brazil, 2020. / Uso dos serviços de saúde e adesão ao distanciamento social por adultos com doenças crônicas na pandemia de COVID-19, Brasil, 2020.

The present study investigates the association between the self-reported diagnosis of noncommunicable disease (NCD) and the adherence to social distancing and the use of health services during the COVID-19 pandemic. This was a cross-sectional study with Brazilian adults who participated in the ConVid- Behavior Survey, conducted online between April 24 and May 24, 2020(n = 45.161). This studyconsidered the following NCDs: diabetes, hypertension, respiratory disease, heart disease, and cancer, and evaluated the use of health services and the adherence to social distancing, as well as estimated the prevalences and adjusted prevalence ratio (aPR); 33,9% (95% CI: 32,5-35,3) referred to one or more NCD. Individuals with NCDsshowed a greater adherence to intense social distancing (aPR: 1,07;95% CI: 1,03-1,11), sought out health services more often (aPR:1,24; 95% CI:1,11-1,38), and found greater difficultyin scheduling doctor's appointments (aPR:1.52; 95% CI 1,35-1,71), receiving healthcare treatment (APR:1,50;95% CI:1,22-1,84) and medication (APR:2,17;95% CI:1,77-2,67), and performing examinations (APR:1,78;95% CI:1,50-2,10) and scheduled interventions (APR:1,65;95% CI:1,16-2,34). The presence of NCDs was associated with social distancing, seeking out health care, and difficulty in using health services.

Este estudo investiga a associação entre diagnóstico autorreferido de Doença Crônica Não Transmissível (DCNT) e adesão ao distanciamento social e utilização dos serviços de saúde durante a pandemia de COVID-19. Estudo transversal com adultos brasileiros que participaram da ConVid Pesquisa de Comportamentos, realizada de 24 de abril a 24 de maio de 2020, via web (n = 45.161). Considerou as DCNT: diabetes, hipertensão, doença respiratória, doença do coração e câncer. Avaliou a utilização de serviços de saúde e a adesão ao distanciamento social. Estimou as prevalências e razões de prevalências ajustadas (RPa). 33,9% (IC95%: 32,5-35,3) referiu uma ou mais DCNT. Indivíduos com DCNT tiveram maior adesão ao distanciamento social intenso (RPa:1,07; IC95%:1,03-1,11), procuraram mais o serviço de saúde (RPa:1,24; IC95%:1,11-1,38) e tiveram mais dificuldades para marcar consulta (RPa:1,52; IC95%:1,35-1,71), conseguir atendimento de saúde (RPa:1,50; IC95%:1,22-1,84) e medicamentos (RPa:2,17; IC95%:1,77-2,67), realizar exames (RPa:1,78; IC95%:1,50-2,10) e intervenções programadas (RPa:1,65; IC95%:1,16-2,34). A presença de DCNT associou-se à maior adesão ao distanciamento social, procura por atendimento de saúde e dificuldade na utilização dos serviços de saúde.

Leisure time physical activity among Brazilian adults: National Health Survey 2013 and 2019.

OBJECTIVE: The aim of this study was to analyze the prevalence of leisure-time physical activity in 2013 and 2019 according to sociodemographic characteristics in Brazilian adults. METHODS: We analyzed data from the National Health Surveys conducted in 2013 and 2019. Prevalence of leisure-time physical activity (150+ minutes per week in physical activities) was calculated according to gender, age, education, race/skin color, Federative Units, and regions of Brazil in 2013 and 2019. Poisson regression models and 95% confidence intervals (95%CI) were used to compare leisure-time physical activity across different groups in 2013 and 2019. RESULTS: The proportion of Brazilian adults active in leisure-time increased from 22.7% (95%CI 22.06-23.34) in 2013 to 30.1% (95%CI 29.44-30.67) in 2019. The prevalence of leisure-time physical activity increased between 2013 and 2019 in 23 of the 27 Federative Units in Brazil. Both in 2013 and in 2019, the proportion of active people during leisure time was higher in men, young people, with a high level of education and individuals with white skin color. Overall, the magnitude of the observed differences in leisure-time physical activity between sociodemographic groups slightly decreased from 2013 to 2019. CONCLUSIONS: Despite the increase in the prevalence of leisure-time physical activity among Brazilian adults in the last six years, marked sociodemographic inequalities persist. The success of future public policies to promote physical activity in leisure must be evaluated from the perspective of social determinants of health and the reduction of inequalities in the practice of physical activity.

Factors associated with cardiovascular disease in the Brazilian adult population: National Health Survey, 2019.

OBJECTIVE: to estimate the prevalence and investigate the sociodemographic, health, and lifestyle factors associated with the self-reported diagnosis of Cardiovascular Disease (CVD) in the adult Brazilian population. METHODS: Data from the National Health Survey (PNS 2019) were analyzed. The presence of CVD was self-reported through the question: "Has any doctor ever given you a diagnosis of heart disease?". Sociodemographic factors, health conditions, and lifestyle were evaluated. For data analysis, Poisson Regression with robust variance was used. RESULTS: 5.3% (95%CI 5.04-5.57) of Brazilian adults reported CVD, of which, 29.08% (95%CI 27.04-31.21) underwent coronary artery bypass surgery or angioplasty and 8.26% (95%CI 7.09-9.6) reported severe limitation in usual activities due to CVD. The factors associated with CVD were advanced age; being male; white race/color; complete middle school and incomplete high school education; have health insurance; self-assessing health as regular or bad/very bad; self-reported hypertension, high cholesterol, and diabetes; being a former smoker; consuming fruits and vegetables as recommended; not consuming alcohol in excess; and not practicing leisure-time physical activity. CONCLUSIONS: CVD is associated with sociodemographic, health, and lifestyle factors. It is important to support public policies, programs, and goals for the reduction of cardiovascular diseases in Brazil, especially in the most vulnerable groups.

Factors associated with increased cigarette consumption in the Brazilian population during the COVID-19 pandemic. / Fatores associados ao aumento do consumo de cigarros durante a pandemia da COVID-19 na população brasileira.

Social distancing measures adopted in various countries to mitigate the impact of the COVID-19 pandemic can lead to unwanted effects on their populations' health and behaviors. This study aimed to investigate smoking behavior in the Brazilian adult population during the COVID-19 pandemic and analyze factors associated with the increase in cigarette consumption. An online survey was performed, and the final sample included 45,160 individuals. The study used post-stratification weights and calculated crude prevalence ratios (PR) and adjusted by sex, age, and schooling, and respective 95% confidence intervals (95%CI). Poisson regression models with robust variance were applied to analyze associations between increased cigarette consumption and sociodemographic variables and adherence to social distancing, quality of sleep, state of mind, and changes in work and earnings. Prevalence of smokers was 12% (95%CI: 11.1-12.9), 34% of whom reported an increase in cigarette consumption. The increase was greater among women (PR = 1.27; 95%CI: 1.01-1.59) and individuals with incomplete secondary schooling (PR = 1.35; 95%CI: 1.02-1.79). The increase in cigarette consumption was associated with worse quality of sleep, feeling isolated from family members or sad, depressed, or anxious, loss of earnings, and worse self-rated health. Health promotion strategies, smoking prevention, and encouragement for smoking cessation, as well as mental health interventions, should be continued and reinforced in the context of social distancing during the COVID-19 pandemic.

Medidas de distanciamento social adotadas em diversos países para mitigar o impacto da pandemia de COVID-19 podem acarretar efeitos indesejáveis sobre a saúde e o comportamento das populações. Este estudo objetivou investigar o comportamento de fumar na população adulta brasileira durante a pandemia de COVID-19 e analisar os fatores associados ao aumento do consumo de cigarro. Foi realizado um inquérito virtual e a amostra final correspondeu a 45.160 indivíduos. Foram utilizados pesos de pós-estratificação e calculadas as razões de prevalência (RP) brutas e ajustadas por sexo, idade e escolaridade, e os respectivos intervalos de 95% de confiança (IC95%). Modelos de regressão de Poisson com variância robusta foram aplicados para a análise de associação entre o aumento do consumo de cigarros e as variáveis sociodemográficas e as relativas à adesão ao distanciamento social, qualidade do sono, estado de ânimo, alteração no trabalho e nos rendimentos. A prevalência de fumantes foi de 12% (IC95%: 11,1-12,9), dos quais 34% relataram aumento no consumo de cigarros. Esse aumento foi maior entre as mulheres (RP = 1,27; IC95%: 1,01-1,59) e entre indivíduos com o Ensino Médio incompleto (RP = 1,35; IC95%: 1,02-1,79). O aumento do consumo de cigarros esteve associado à piora da qualidade do sono, sentir-se isolado dos familiares, triste ou deprimido, ansioso, ficar sem rendimentos e pior avaliação do estado de saúde. Estratégias de promoção da saúde, de prevenção do uso e de incentivo à cessação do consumo de cigarros, bem como intervenções em saúde mental, devem ser continuadas e reforçadas no contexto de distanciamento social durante a pandemia de COVID-19.

Las medidas de distanciamiento social adoptadas en diversos países para mitigar el impacto de la pandemia de COVID-19 pueden acarrear efectos indeseables sobre la salud y el comportamiento de las poblaciones. Este estudio tuvo como objetivo investigar el comportamiento de fumar en la población adulta brasileña, durante la pandemia de COVID-19, y analizar los factores asociados al aumento del consumo de tabaco. Se realizó una encuesta virtual y la muestra final correspondió a 45.160 individuos. Se utilizaron pesos de pos-estratificación y se calcularon las razones de prevalencia (RP) brutas y ajustadas por sexo, edad y escolaridad, así como los respectivos intervalos de 95% de confianza (IC95%). Se aplicaron modelos de regresión de Poisson con variancia robusta para el análisis de asociación entre el aumento del consumo de tabaco y las variables sociodemográficas, así como las relativas a la adhesión al distanciamiento social, calidad del sueño, estado de ánimo, cambios en el trabajo e ingresos. La prevalencia de fumadores fue de un 12% (IC95%: 11,1-12,9), de los cuales un 34% relataron un aumento en el consumo de cigarrillos. Este aumento fue mayor entre las mujeres (RP = 1,27; IC95%: 1,01-1,59) y entre individuos con la enseñanza media incompleta (RP = 1,35; IC95%: 1,02-1,79). El aumento del consumo de tabaco estuvo asociado con un empeoramiento de la calidad del sueño, sentirse aislado de los familiares, triste o deprimido, ansioso, quedarse sin ingresos, al igual que con una peor evaluación del estado de salud. Las estrategias de promoción de salud, prevención del consumo y de alicientes para dejar el hábito de fumar, así como intervenciones en salud mental, deben ser continuas y estar reforzadas en el contexto de distanciamiento social durante la pandemia de COVID-19.

The COVID-19 pandemic and changes in the lifestyles of Brazilian adolescents.

OBJECTIVE: To analyze changes in the lifestyles of Brazilian adolescents during the COVID-19 pandemic. METHODS: Cross-sectional study carried out with adolescents who participated in the survey "ConVid Adolescentes - Pesquisa de Comportamentos". The indicators related to lifestyles before and during the COVID-19 pandemic were evaluated: consumption of healthy and unhealthy foods, physical activity and sedentary behavior, smoking and consumption of alcohol. Prevalence and 95% confidence intervals were calculated for the total population and according to sex and age group. RESULTS: A total of 9,470 adolescents participated in the study. During the period of social distancing, there was an increase in the prevalence of vegetables consumption (from 27.34 to 30.5%), frozen foods (from 13.26 to 17.3%), chocolates and sweets (from 48.58 to 52.51%), and time in front of screens (from 44.57 to 70.15%). On the other hand, there was a decrease in the practice of physical activity (from 28.70 to 15.74%) and in the consumption of alcohol (from 17.72 to 12.77%). Differences were observed according to sex and age group. CONCLUSION: The results show changes in the lifestyle of adolescents and an increase in health risk behaviors.

Temporal trend in the prevalence of indicators related to driving a motor vehicle after alcohol consumption, between 2007 and 2018. / Tendência temporal da prevalência de indicadores relacionados à condução de veículos motorizados após o consumo de bebida alcoólica, entre os anos de 2007 e 2018.

OBJECTIVE: To analyze the temporal trend of indicators related to motor vehicle driving after alcohol consumption, in the general population and among drivers. METHODS: Temporal trend study of indicators related to driving motorized vehicles after alcohol consumption, between 2007 and 2018, based on information from Vigitel. The population consisted of adults (≥ 18 years old) living in Brazilian capitals with a landline. Trend analysis was performed by linear regression. RESULTS: Between 2007 and 2018, there was a reduction in the indicator "driving a vehicle after alcohol abuse by the population" from 2.0% to 0.7% (p < 0.001). This consumption when calculated only among drivers decreased from 3.5 in 2011 to 1.6 in 2018 (p < 0.003). Driving a vehicle by drivers after consuming any amount of alcohol had high prevalences, ranging from 15.7% (2011) to 11.4% (2018). Prevalence in all indicators was higher among men, younger adults (18 to 34 years) and with higher education. CONCLUSION: The practice of alcohol abuse and driving reduced in Brazil, however, driving after drinking any amount of alcohol still remains high. Therefore, it is necessary to maintain regulatory measures to control alcohol and driving in order to reduce traffic accidents.

Inequalities in mammography and Papanicolaou test coverage: a time-series study.

BACKGROUND: Cancer is a serious public issue problem worldwide. In Brazil, breast cancer is the most common type and cervical cancer is the third most frequent among women. OBJECTIVE: To analyze the temporal trend of coverage of mammography and cervical oncotic cytological testing, between 2007 and 2018. DESIGN AND SETTING: Time-series study conducted in the 26 Brazilian state capitals and in the Federal District. METHODS: A linear regression model was used to estimate trends in coverage of mammography and cervical oncotic cytological testing over the period. The data collection system for Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey (Vigitel) was used. RESULTS: A significant increase in mammography coverage was observed, from 71.1% in 2007 to 78.0% in 2018. There was a trend towards an increase among women with 0 to 8 years of schooling, in all regions of Brazil. Regarding cervical oncotic cytological testing coverage, there was a trend towards stability during the period analyzed, reaching 81.7% in 2018. On the other hand, there was a significant increase in the northern region. CONCLUSIONS: There was an improvement in the coverage of these screening examinations, especially regarding mammography. However, it is still necessary to expand their provision, quality and surveillance, aimed towards women's health.

Noncommunicable diseases in the Journal Ciência & Saúde Coletiva: a bibliometric study. / Doenças Crônicas Não Transmissíveis na Revista Ciência & Saúde Coletiva: um estudo bibliométrico.

Noncommunicable Diseases are an important public health issue in Brazil and worldwide. This study aimed to analyze the scientific production published by the "Journal Ciência & Saúde Coletiva" in order to shed light on its contributions for the dissemination of scientific knowledge and the debate regarding noncommunicable diseases. A bibliometric study on the publications from 1996 to 2019 related to noncommunicable diseases was carried out. A total of 458 documents that met the eligibility criteria were selected. An increasing trend in the number of publications per year was found; at some points, it coincided with political and institutional milestones in Brazil. Quantitative research papers stood out, as did studies on risk and protective factors. Public educational and research institutions led the publishing and the financing of the studies. Most authors were female. The journal has been reflecting the magnitude of the theme and its prioritization on the public agenda by promoting the debate and providing a scientific dissemination of content related to noncommunicable diseases.

As Doenças Crônicas Não Transmissíveis configuram importante problema de saúde pública no Brasil e no mundo. Visando conferir visibilidade às contribuições da revista Ciência & Saúde Coletiva para a divulgação do conhecimento científico e o debate das questões relacionadas às Doenças Crônicas Não Transmissíveis, o presente estudo teve por objetivo analisar a produção científica publicada pela revista. Realizou-se um estudo bibliométrico das publicações veiculadas no período de 1996 a 2019, referentes a essas doenças. Com base em critérios de elegibilidade, selecionou-se um total de 458 publicações. Observou-se tendência temporal de aumento das publicações, coincidente com o estabelecimento de marcos político-institucionais no país. Destacaram-se os artigos quantitativos e os estudos sobre fatores de risco e proteção. Evidenciou-se a liderança das instituições públicas de ensino e pesquisa na produção científica sobre o tema e, também, no financiamento público dos estudos. Os autores que mais publicaram são majoritariamente do sexo feminino. A revista vem refletindo a magnitude e a prioridade da temática na agenda pública ao promover o debate e oportunizar a divulgação científica sobre as doenças crônicas.

[Time trends in morbid obesity prevalence in the Brazilian adult population from 2006 to 2017]. / Tendência temporal da prevalência de obesidade mórbida na população adulta brasileira entre os anos de 2006 e 2017.

This study was an assessment of time trends in morbid obesity prevalence in the adult population in Brazil's state capitals from 2006 to 2017. A cross-sectional study was performed with data from the Risk and Protective Factors Surveillance System for Chronic Noncommunicable Diseases Through Telephone Interview (Vigitel), analyzed by simple linear regression. The results showed an upward trend in morbid obesity prevalence in Brazil. Women showed higher prevalence rates (1.3% in 2006 and 1.9% in 2017) when compared to men (0.9% and 1.4%). The 25-44-year age bracket showed an upward trend from 0.9% to 2.1% (p < 0.001). There was an increase in morbid obesity in all levels of schooling and all regions of Brazil. The state capitals with upward trends in males were Campo Grande, Curitiba, Fortaleza, Macapá, Manaus, Palmas, Porto Velho, Rio Branco, and Teresina. In females, they were Belo Horizonte, Campo Grande, Rio de Janeiro, and Teresina. The growth in morbid obesity in Brazil sounds a warning on the urgent need to adopt measures to detain it, such as regulation of ultra-processed foods and health education measures for the entire population.

Para a avaliação da tendência temporal da prevalência de obesidade mórbida na população adulta das capitais brasileiras entre os anos 2006 e 2017, foi realizado estudo transversal com dados da Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel), analisados por regressão linear simples. Resultados evidenciaram tendência de aumento da prevalência de obesidade mórbida no Brasil. As mulheres apresentaram maiores prevalências (1,3%, em 2006, e 1,9%, em 2017) ao serem comparadas com os homens (0,9% e 1,4%). Na faixa etária entre 25 a 44 anos, a tendência foi de crescimento de 0,9% para 2,1% (p < 0,001). Em todos os níveis de escolaridade e regiões do Brasil, houve aumento da obesidade mórbida. As capitais que apresentaram tendência de aumento no sexo masculino foram: Campo Grande, Curitiba, Fortaleza, Macapá, Manaus, Palmas, Porto Velho, Rio Branco e Teresina. Em relação ao sexo feminino: Belo Horizonte, Campo Grande, Rio de Janeiro e Teresina. O crescimento da obesidade mórbida no país constitui um alerta para a urgente necessidade de adotar medidas para detê-la, como a regulação de alimentos ultraprocessados e ações de educação para a saúde para toda a população.

Evaluación de la tendencia temporal de la prevalencia de obesidad mórbida en la población adulta de capitales brasileñas entre los años 2006 y 2017. Se realizó un estudio transversal con datos procedentes de la Vigilancia de Factores de Riesgo y Protección para Enfermedades Crónicas No Transmisibles por Entrevista Telefónica (Vigitel), analizados por regresión lineal simple. Los resultados evidenciaron una tendencia de aumento de la obesidad mórbida en Brasil. Las mujeres presentaron mayores prevalencias (1,3% en 2006 y 1,9% en 2017) al compararlas con los hombres (0,9% y 1,4%). En la franja de edad entre 25 a 44 años la tendencia fue de crecimiento de 0,9% a 2,1% (p < 0,001). En todos los niveles de escolaridad y regiones de Brasil hubo un aumento de obesidad mórbida. Las capitales que presentaron una tendencia de aumento en el sexo masculino fueron: Campo Grande, Curitiba, Fortaleza, Macapá, Manaus, Palmas, Porto Velho, Río Branco y Teresina. En relación con el sexo femenino: Belo Horizonte, Campo Grande, Río de Janeiro y Teresina. El crecimiento de la obesidad mórbida en el país constituye una alerta para la necesidad urgente de adoptar medidas con el fin de detenerla como pueden ser la regulación de alimentos ultraprocesados, así como acciones educativas para la salud de toda la población.

Trends in smoking prevalence in all Brazilian capitals between 2006 and 2017.

OBJECTIVE: To evaluate the trends in smoking prevalence in all Brazilian capitals between 2006 and 2017. METHODS: This was a study of temporal trends in smoking, based on information from the Telephone-based System for the Surveillance of Risk and Protective Factors for Chronic Diseases. The trends in smoking prevalence were stratified by gender, age, level of education, and capital of residence. We used linear regression analysis with a significance level of 5%. RESULTS: From 2006 to 2017, the overall prevalence of smoking in the Brazilian capitals declined from 19.3% to 13.2% among men and from 12.4% to 7.5% among women (p < 0.05 for both). Despite the overall decline in the prevalence of smoking in all of the capitals, the rate of decline was lower in the more recent years. There was also a reduction in the prevalence of former smoking (22.2% in 2006 to 20.3% in 2017). In contrast, there was an upward trend in the prevalence of former smoking among individuals with a lower level of education (from 27.9% in 2006 to 30.0% in 2017). In 2017, the prevalence of smoking among men was highest in the cities of Curitiba, São Paulo, and Porto Alegre, whereas it was highest among women in the cities of Curitiba, São Paulo, and Florianópolis. CONCLUSIONS: There have been improvements in smoking prevalence in Brazil. Annual monitoring of smoking prevalence can assist in the battle against chronic noncommunicable diseases.

Prevalence of hemoglobinopathies in the Brazilian adult population: National Health Survey 2014-2015. / Prevalência de hemoglobinopatias na população adulta brasileira: Pesquisa Nacional de Saúde 2014-2015.

OBJECTIVE: To describe the prevalence of hemoglobinopathies in the Brazilian adult population, according to laboratory tests from the National Health Survey. METHODS: A descriptive study was carried out with National Health Survey laboratory data collected between 2014 and 2015. The hemoglobinopathies test was performed using the High Performance Liquid Chromatography method. The results of the individual tests were interpreted as providing normal, homozygous or heterozygous results for S, C and D hemoglobin, in addition to other possible hemoglobinopathies. Prevalence of hemoglobinopathies according to gender, skin color, region, age and schooling was estimated. RESULTS: Hemoglobinopathies were present in 3.7% of the population. The main ones were the sickle cell trait (2.49%), thalassemia minor (0.30%) and suspected thalassemia major (0.80%). In relation to the sickle cell trait and suspected thalassemia major, there was a statistically significant difference for the skin color variable (p<0.05). The prevalences found for sickle cell trait according to skin color was: 4.1% among dark-skinned blacks, 3.6% among light-skinned blacks, 1.2% among whites, and 1.7% among others. CONCLUSION: The most prevalent hemoglobinopathies were the sickle cell trait and minor thalassemia, and were predominate among light- and dark-skinned black people. The study helps in identifying hemoglobinopathies and in genetic counseling in pre-conception.

OBJETIVO: Descrever a prevalência das hemoglobinopatias da população adulta brasileira, segundo exames laboratoriais da Pesquisa Nacional de Saúde. MÉTODOS: Estudo descritivo realizado com os dados laboratoriais da Pesquisa Nacional de Saúde coletados entre os anos de 2014 e 2015. A pesquisa de hemoglobinopatias foi feita pelo método da cromatografia líquida de alto desempenho. Os resultados dos exames individuais foram interpretados fornecendo os parâmetros normais, homozigotos ou heterozigotos para hemoglobina S, C e D, além de outras eventuais hemoglobinopatias. Foram estimadas prevalências das hemoglobinopatias segundo sexo, cor da pele, região, idade e escolaridade. RESULTADOS: Houve presença de hemoglobinopatias em 3,7% da população. As principais foram o traço falciforme (2,49%), a talassemia menor (0,30%) e a suspeita de talassemia maior (0,80%). Em relação ao traço falciforme e à suspeita de talassemia maior, houve diferença estatisticamente significativa para a variável cor da pele (p < 0,05). As prevalências encontradas para traço falciforme segundo cor de pele foram: preta (4,1%), parda (3,6%), branca (1,2%) e outras (1,7%). CONCLUSÃO: As hemoglobinopatias mais prevalentes foram o traço falciforme e a talassemia menor, predominando entre pretos e pardos. O estudo ajuda na identificação das hemoglobinopatias e no aconselhamento genético na preconcepção.

Reference values for laboratory tests of cholesterol, glycosylated hemoglobin and creatinine of the Brazilian adult population. / Valores de referência para exames laboratoriais de colesterol, hemoglobina glicosilada e creatinina da população adulta brasileira.

INTRODUCTION: This article aims to estimate reference values for laboratory tests of cholesterol, glycosylated hemoglobin and creatinine for the Brazilian adult population. METHODS: A descriptive study carried out with laboratory data from the National Health Survey (Pesquisa Nacional de Saúde - PNS). Samples of blood and urine were collected in a PNS subsample of 8,952 individuals aged 18 years old or older. To determine the reference values, exclusion criteria were applied: presence of previous diseases and outliers, defined by values outside the range estimated by the mean ± 1.96 × standard deviation. Subsequently, reference values were calculated according to gender, age group and race/skin color. RESULTS: Differences in reference values according to gender were observed. Women had higher values of total cholesterol, LDL-c and HDL-c. Glycosylated hemoglobin showed similar values in relation to gender, and creatinine was higher among men. The mean reference values were higher in the elderly population, aged 60 years old or older. The mean, lower and upper limits of total cholesterol and fractions of non-white people were slightly lower. There was no difference according to race/skin color for glycosylated hemoglobin and creatinine. CONCLUSION: The establishment of national reference parameters for laboratory tests, adapted to the sociodemographic and geographic characteristics, provides relevant information for evaluation of diagnosis and treatment of chronic diseases in Brazil.

INTRODUÇÃO: Este artigo teve o objetivo de estimar valores de referência de exames laboratoriais de colesterol, hemoglobina glicosilada e creatinina para a população adulta brasileira. MÉTODOS: Estudo descritivo realizado com os dados laboratoriais da Pesquisa Nacional de Saúde (PNS). Foram coletadas amostras de sangue e urina em subamostra da PNS constituída de 8.952 indivíduos de 18 anos ou mais. Para determinar os valores de referência, aplicaram-se critérios de exclusão, como a presença de doenças prévias e dos outliers, definidos pelos valores fora do intervalo estimado pela média ± 1,96 × desvio padrão. Posteriormente, foram calculados os valores de referência segundo sexo, faixa etária e raça/cor. RESULTADOS: Observaram-se diferenças nos valores de referência de acordo com o sexo. O colesterol total, a lipoproteína de baixa densidade colesterol (LDL-c) e a lipoproteína de alta densidade colesterol (HDL-c) apresentaram valores mais elevados entre as mulheres. A hemoglobina glicosilada alcançou valores semelhantes segundo sexo, e a creatinina foi mais elevada entre os homens. Os valores médios de referência foram mais altos na população idosa, de 60 anos ou mais. A média e os limites inferiores e superiores do colesterol total e frações dos indivíduos não brancos foram ligeiramente mais baixos. Não houve diferença segundo raça/cor para hemoglobina glicosilada nem para creatinina. CONCLUSÃO: O estabelecimento de parâmetros nacionais de referência de exames laboratoriais, adaptados às características sociodemográficas e geográficas, fornece subsídios relevantes para a avaliação do diagnóstico e tratamento de doenças crônicas no Brasil.

Reference values for blood count laboratory tests in the Brazilian adult population, National Health Survey. / Valores de referência para exames laboratoriais de hemograma da população adulta brasileira: Pesquisa Nacional de Saúde.

OBJECTIVE: To describe reference values for blood counts obtained from laboratory tests in the Brazilian adult population according to laboratory results from the National Health Survey (Pesquisa Nacional de Saúde - PNS), by gender, age group and skin color. METHODS: The initial sample consisted of 8,952 adults. To determine the reference values, individuals with prior diseases and outliers were excluded. Mean values, standard deviation and limits were stratified by gender, age group and skin color. RESULTS: For red blood cells, men presented a mean value of 5.0 million per mm3 (limits: 4.3-5.8) and women, 4.5 million per mm3 (limits: 3.9-5.1). Hemoglobin levels were higher among men with a mean of 14.9 g/dL (13.0-16.9), and in women, 13.2 g/dL (11.5-14.9). The mean number of white blood cells among men was 6.142/mm3 (2.843-9.440) and 6.426/mm3 (2.883-9.969) for women. Other parameters showed close values between the genders. Regarding age groups and skin color, mean values, standard deviation and limits of the exams presented small variations. CONCLUSION: Hematological reference values based on the national survey allow for the establishment of specific reference limits for gender, age and skin color. The results presented here may contribute to the establishment of better evidence and criteria for the care, diagnosis and treatment of diseases.

OBJETIVO: Descrever valores de referência para exames laboratoriais de hemograma da população adulta brasileira segundo os resultados laboratoriais da Pesquisa Nacional de Saúde (PNS) estratificados por sexo, faixa etária e cor da pele. MÉTODOS: A amostra foi constituída inicialmente de 8.952 adultos. Para determinar os valores de referência, excluíram-se indivíduos com doenças prévias e os outliers. Valores médios, desvio padrão e limites foram estratificados por sexo, faixa etária e cor da pele. RESULTADOS: Para glóbulos vermelhos, os homens apresentaram valor médio de 5,0 milhões por mm3 (limites: 4,3-5,8) e as mulheres 4,5 milhões por mm3 (limites: 3,9-5,1). Valores de hemoglobina entre homens exibiram média de 14,9 g/dL (13,0-16,9) e entre mulheres de 13,2 g/dL (11,5-14,9). A média dos glóbulos brancos entre os homens foi de 6.142/mm3 (2.843-9.440) e entre as mulheres de 6.426/mm3 (2.883-9.969). Outros parâmetros mostraram valores próximos entre os sexos. Com relação a faixas etárias e cor da pele, valores médios, desvio padrão e limites dos exames apontaram pequenas variações. CONCLUSÃO: Os valores de referência hematológicos com base em inquérito nacional permitem a definição de limites de referência específicos por sexo, idade e cor da pele. Os resultados aqui expostos podem contribuir para o estabelecimento de melhores evidências e critérios para o cuidado, diagnóstico e tratamento de doenças.

Prevalence of diabetes mellitus as determined by glycated hemoglobin in the Brazilian adult population, National Health Survey. / Prevalência de diabetes mellitus determinada pela hemoglobina glicada na população adulta brasileira, Pesquisa Nacional de Saúde.

OBJECTIVE: To analyze the prevalence of diabetes mellitus (DM) according to different diagnostic criteria, in the Brazilian adult population, according to laboratory results from the Brazilian National Health Survey. METHODS: Analysis of laboratory data from the National Health Survey, collected between 2014 and 2015. The prevalence of diabetes was calculated according to different diagnostic criteria. The prevalence of diabetes was calculated according to the criterion of glycosylated hemoglobin ≥ 6.5% or using medication, using Poisson regression and calculating crude and adjusted PR and 95%CI. RESULTS: The prevalence of diabetes according to different criteria varies from 6.6 to 9.4%. Intermediate or pre-diabetes hyperglycemia ranged from 6.8 to 16.9%. Considering laboratory criteria or medication use, the prevalence of DM was 8.4 (95%CI 7.65-9.11). The adjusted PR for gender, age, educational level and region was lower for males (PR 0.75; 95%CI 0.63 - 0.89), increased with age: 30 to 34 years (PR 2.32; 95% CI 1.33 - 4.07), 40 to 59 years PR 8.1; 95%CI 4.86 - 13.46), 60 years old or older (PR 12.6; 95%CI 7.1 - 21.0), and higher educational levels was protective (PR 0.8; 95%CI 0.6 - 0.9). Therewas a higher PR in the Central West Region (PR 1.3; 95%CI 1.04 - 1.7), in overweight people (PR 1.8; 95%CI 1.4 - 2.1), and in obese people (PR 3.3; 95%CI 2.6 - 4.1). CONCLUSION: The prevalence of diabetes was higher in females, people over 30 years of age, in populations with low educational levels, and people who were overweight and obese. The study advances in determining the diabetes situation in the country through laboratory criteria.

OBJETIVO: Analisar as prevalências de diabetes mellitus segundo diferentes critérios diagnósticos, na população adulta brasileira, segundo os resultados laboratoriais da Pesquisa Nacional de Saúde. MÉTODOS: Análise dos dados laboratoriais da Pesquisa Nacional de Saúde, coletados entre os anos de 2014 e 2015. Foram calculadas as prevalências de diabetes conforme diferentes critérios diagnósticos. Foram calculadas as prevalências de diabetes segundo o critério de hemoglobina glicosilada ≥ 6,5% ou em uso de medicamentos, empregando regressão de Poisson para o cálculo da razão de prevalência (RP) bruta e ajustada e intervalo de confiança de 95% (IC95%). RESULTADOS: A prevalência de diabetes segundo diferentes critérios pode variar 6,6 a 9,4%; e a hiperglicemia intermediária, ou pré-diabetes, de 6,8 a 16,9%. Usando-se o critério laboratorial ou uso de medicamentos, a prevalência de diabetes foi de 8,4%. A RP ajustada para sexo, idade, escolaridade e região foi menor no sexo masculino (RP = 0,75; IC95% 0,63 - 0,89); aumentou com a idade: 30 a 34 anos (RP=2,32; IC95% 1,33 - 4,07), 40 a 59 anos (RP = 8,1; IC95% 4,86 - 13,46), 60 anos ou mais (RP = 12,6; IC95% 7,1 - 21,0); e a escolaridade elevada foi protetora (RP = 0,8; IC95% 0,6 - 0,9). Maior RP foi encontrada na Região Centro-Oeste (RP = 1,3; IC95% 1,04 - 1,7) e naqueles com sobrepeso (RP = 1,8; IC95% 1,4 - 2,1) e obesidade (RP = 3,3; IC95% 2,6 - 4,1). CONCLUSÃO: A prevalência de diabetes foi maior no sexo feminino, naqueles com idade maior que 30 anos, em população com baixa escolaridade, com excesso de peso e obesidade. Os critérios laboratoriais são mais fidedignos para o conhecimento da situação real do diabetes no país.

Doenças crônicas não transmissíveis e seus fatores de risco na população beneficiária do Programa Bolsa Família: uma revisão integrativa / Chronic non-communicable diseases and their risk factors in the bolsa família program beneficiary population: an integrative review / Enfermedades crónicas no transmisibles y sus factores de riesgo en la población que se beneficia del programa bolsa família: una revisión integradora

Objetivo: sintetizar as evidências científicas sobre a ocorrência de doenças crônicas não transmissíveis (DCNT) e seus fatores de risco (FR) na população beneficiária do Programa Bolsa Família (PBF). Métodos: trata-se de uma revisão integrativa da literatura, cuja busca por publicações de 2004 a 2020 foi feita nas seguintes bases de dados: Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS) e Indice Bibliográico Español en Ciencias de la Salud (IBECS), via Biblioteca Virtual da Saúde (BVS); Medline, via Pubmed, SCOPUS (via Portal CAPES); e Scientific Electronic Library Online - SciELO. Resultados: foram selecionados 23 artigos, os quais foram agrupados em três categorias: 1) Prevalência dos fatores de risco para DCNT em mulheres beneficiárias do PBF: as mulheres beneficiárias apresentaram piores desfechos no consumo de tabaco, menor prática de atividade física, maior prevalência de diabetes, hipertensão e obesidade; 2) Estado nutricional e insegurança alimentar em crianças, adolescentes e famílias beneficiárias do PBF: os estudos apontaram para uma elevada prevalência de obesidade e coexistência de déficit estatural em crianças beneficiárias; e 3) Consumo alimentar de beneficiários do PBF: foi identificado um padrão não saudável de alimentação. Conclusão: usuários do PBF apresentam elevadas prevalências de fatores de risco para doenças crônicas não transmissíveis e pior padrão alimentar. Esses dados reforçam a importância de o PBF estar sendo direcionado às populações mais vulneráveis, visando mitigar as imensas desigualdades sociais. No entanto, é necessário avançar em outras políticas públicas de proteção social que impactem os determinantes sociais e melhorem a qualidade de vida de extensa camada da população brasileira.(AU)

occurrence and their risk factors (RF) in the Bolsa Família Program (BFP) beneficiary population. Methods: this is an integrative literature review whose search for publications from 2004 to 2020 was carried out in the following databases: Latin American and Caribbean Literature in Health Sciences (LILACS) and Indice Bibliográico Español en Ciencias de la Salud (IBECS), via the Virtual Health Library (VHL); Medline, via Pubmed, Scopus (via Portal CAPES); and Scientific Electronic Library Online - SciELO. Results: 23 articles were selected and grouped into three categories: 1) Prevalence of risk factors for NCDs in BFP beneficiary women: beneficiary women had worse outcomes in tobacco consumption, lower physical activity, higher prevalence of diabetes, hypertension, and obesity; 2) Nutritional status and food insecurity in BFP beneficiary children, adolescents and families: the studies pointed to a high prevalence of obesity and coexistence of height deficit in beneficiary children; and 3) Food consumption of BFP beneficiaries: an unhealthy eating pattern was identified. Conclusion: BFP users have a high prevalence of risk factors for chronic non-communicable diseases and worse dietary patterns. These data reinforce the importance of the BFP being directed to the most vulnerable populations, aiming to mitigate the immense social inequalities. However, it is necessary to advance other public policies of social protection that impact the social determinants and improve the life quality of a large part of the Brazilian population.(AU)

Objetivo: sintetizar evidencias científicas sobre la ocurrencia de enfermedades crónicas no transmisibles (ECNT) y sus factores de riesgo (FR) en la población beneficiaria del Programa Bolsa Familia (PBF). Método: se trata de una revisión bibliográfica integradora, cuya búsqueda de publicaciones entre 2004 y 2020 fue realizada en las bases de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS) e Índice Bibliográfico Español en Ciencias de la Salud (IBECS) a través de la Biblioteca Virtual en Salud (BVS), Medline a través del Pubmed, Scopus (vía Portal CAPES) y Scientific Electronic Library Online - SciELO...(AU)