A comprehensive integrated dataset on Brazilian health facilities: from 2005 to 2021.

OBJECTIVES: The National Registry of Healthcare Facilities is a system with the registry of every healthcare facility in Brazil with information on the capacity building and healthcare workforce regarding its public or private nature. Despite being publicly available, it can only be accessed in separated disjoint tables, with different primary units of analysis. The objective is to offer an interoperable dataset containing monthly data from 2005 to 2021 with information on healthcare facilities, including their physical and human resources, services and teams, enriched with municipal information. DATA DESCRIPTION: Database with historical data and geographic information for each health facility in Brazil. It is composed by 5 distinct tables, organized according to combinations of time, space, and types of resources, services and teams. This database opens up a range of possibilities for research topics, from case studies in a single health facility and period, analysis of a group of health facilities with characteristics of interest, to a broader study using the entire dataset and aggregated data by municipality. Furthermore, the fact that there is a row for each health facility/month/year facilitates the integration with other datasets from the Brazilian healthcare system. In addition to being a potential object of study in the health area, the dataset is also convenient in data science, especially for studies focused on time series.

Primary health care coverage in Brazil: a dataset from 1998 to 2020.

OBJECTIVES: Primary health care builds the backbone of an effective healthcare system and can improve population health, reduce cost growth, and lessen inequality. We offer a machine-readable and open-access dataset on primary health care coverage in Brazil from 1998 to 2020. This dataset is interoperable with epidemiological data from two major studies and reusable by the research community worldwide for other purposes, such as monitoring progress toward universal health coverage and studying the association between primary health care and health outcomes. DATA DESCRIPTION: The dataset gathers official and public information from the "e-Gestor AB" platform of the Ministry of Health of Brazil and restricted data obtained by the Brazilian Access to Information Law. It includes 1,509,870 observations and 35 attributes aggregated by months/years and policy-relevant geographic units (country, macroregions, states, municipalities, and capitals) on primary health care team count and their absolute and relative population coverage estimates, information on the More Doctors Program implementation and physician counts, and spatial, demographic, and socioeconomic characteristics. We automated all data processing and curation in the free and open software R. The codes can be audited, replicated, and reused to produce alternative analyses.

Dataset on child vaccination in Brazil from 1996 to 2021.

We present a machine-readable and open-access dataset on vaccination results among children under five years old in Brazil from 1996 to 2021. This dataset is interoperable with epidemiological data from the VAX*SIM project and reusable by the research community worldwide for other purposes, such as monitoring vaccination coverage and studying its determinants and impacts on child morbidity and mortality. The dataset gathers official and public information from the Brazilian National Immunisation Program, the Institute of Geography and Statistics, the Institute for Applied Economic Research, and the Ministry of Health. It includes 2,442,863 observations and 35 attributes aggregated by years, policy-relevant geographic units (country, macroregions, states, municipalities, and capitals), and age groups on 1,344,480,329 doses of 28 vaccines aimed to prevent 15 diseases, estimates of their target-population coverage, indicators of the vaccination coverage's homogeneity, dropout rates, and spatial, demographic, and socioeconomic data. We automated all data processing and curation in the free and open software R. The codes can be audited, replicated, and reused to produce alternative analyses.

Prevalence and temporal trends in prepregnancy nutritional status and gestational weight gain of adult women followed in the Brazilian Food and Nutrition Surveillance System from 2008 to 2018.

Prepregnancy body mass index (BMI) and gestational weight gain (GWG) are the most investigated indicators of maternal nutritional status, which is a modifiable factor that plays a vital role in maternal and infant health. This study describes prepregnancy BMI and GWG of 840,243 women with 2,087,765 weight observations in the Brazilian Food and Nutrition Surveillance System from 2008 to 2018. Prepregnancy BMI was classified according to the World Health Organization cut-offs. Total GWG was calculated from weight measurements taken after 36 weeks of pregnancy and classified according to the Institute of Medicine guidelines. Temporal trends in prepregnancy BMI status were examined, and maps were used to evaluate changes in excessive GWG in each Brazilian federation unit. On overall, prepregnancy overweight and obesity increased from 22.6% to 28.8% and from 9.8% to 19.8%, respectively, between 2008 and 2018. The prevalence of excessive GWG rose from 34.2% to 38.7% during the same period and in 11 of the 27 Brazilian federation units between 2008 and 2016. Women with underweight showed the highest values for mean total GWG for all the compared years (overall variation from 12.3 to 13.1 kg), followed by those with normal weight (11.9 to 12.5 kg), overweight (10.1 to 10.9 kg) and obesity (from 8.2 to 8.9 kg). Within each BMI group, values remained fairly stable throughout the studied period for first- and second-trimester GWG and total GWG. These results help to fill a significant gap in understanding the distribution of prepregnancy BMI and GWG in Brazilian women.

Multisystem inflammatory syndrome in children: a cross-sectional study of cases and factors associated with deaths during the COVID-19 pandemic in Brazil, 2020. / Síndrome inflamatória multissistêmica pediátrica: estudo seccional dos casos e fatores associados aos óbitos durante a pandemia de COVID-19 no Brasil, 2020.

OBJECTIVE: To characterize the clinical-epidemiological profile of multisystem inflammatory syndrome in children temporally associated with COVID-19 (MIS-C), and to identify factors associated with MIS-C deaths in Brazil, 2020. METHODS: This was a cross-sectional study, using national MIS-C monitoring data. Logistical regression was performed to estimate crude and adjusted odds ratios (OR). RESULTS: Median case (n=652) age was 5 years, 57.1% were male, 52.0% were of brown race/skin color and 6.4% died. Likelihood of death was greater among those who presented O2 saturation <95% (ORa=4.35 - 95%CI 1.69;11.20) and altered urea results (ORa=5.18 - 95%CI 1.91;14.04); likelihood of death was lower when red skin blotches were not present (ORa=0.23 - 95%CI 0.09;0.62), when anticoagulants were used (ORa=0.32 - 95%CI 0.12;0.89) and when immunoglobulins were used (ORa=0.38 - 95%CI 0.15;1.01). CONCLUSION: Fatality ratios were higher among cases that presented O2 saturation <95% and altered urea results. Fatality ratios were lower among those with red skin blotches, and those who used immunoglobulins and anticoagulants.

National congenital anomaly registers in the world: historical and operational aspects. / Registros nacionais de anomalias congênitas no mundo: aspectos históricos e operacionais.

OBJECTIVE: To identify registers of congenital anomalies with national coverage currently available around the world, highlighting their main historical and operational characteristics. METHODS: This was a documentary study by means of a Medline database search (via PubMed) and searches involving reports, official documents and websites. Studies reporting at least one national registry were included. RESULTS: 40 registers of national congenital anomalies were identified in 39 different countries. All registers included in the study were concentrated in upper-middle or high-income countries located in Europe. Most of the registers were population-based, compulsory notification and with a time limit for notification of up to 1 year of age. The Brazilian register showed the highest annual coverage. CONCLUSION: The registers analyzed showed different characteristics, related to the reality of each country. The results presented provide support for the theme of congenital anomalies surveillance, especially in places where such activity is intended to be implemented.

Database on the coverage of the "Bolsa-Família" conditioning cash-transfer program: Brazil, 2005 to 2021.

OBJECTIVES: The "Bolsa-Família" Program (PBF) is a Brazilian conditional cash-transfer program in which families should comply with health, education, and social assistance conditionalities. The program aims to fight poverty and hunger, promoting nutrition and health services for low-income populations. This paper presents a database on the coverage of monitoring and compliance with the PBF health conditionalities in Brazil from January 2005 to July 2021. DATA DESCRIPTION: Database on the PBF conditioning cash-transfer program coverage in Brazil from 2005 to 2021. It comprises information on the number of families benefited, health conditionalities, and the follow-up on vaccination and nutrition of children under seven years old. The cities and semesters are the minimal aggregation units.

List of priority congenital anomalies for surveillance under the Brazilian Live Birth Information System. / Lista de anomalias congênitas prioritárias para vigilância no âmbito do Sistema de Informações sobre Nascidos Vivos do Brasil.

OBJECTIVE: To define the list of priority congenital anomalies for improving their recording on the Brazilian Live Birth Information System (Sinasc). METHODS: Based on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), international protocols and meetings with specialists, the list of priority anomalies was built considering two main criteria: being diagnosable at birth and having intervention available at different levels. The list was submitted for consideration by the Brazilian Medical Genetics and Genomics Society. RESULTS: The list comprised eight groups of congenital anomalies distributed according to the type of related anomaly, as well as the affected part of the body and its corresponding code in ICD-10 Chapter XVII. CONCLUSION: The list of priority congenital anomalies for notification provides a basis for improving case recording on Sinasc.

Registros nacionais de anomalias congênitas no mundo: aspectos históricos e operacionais / Registros nacionales de anomalías congénitas en el mundo: aspectos históricos y operativos / National congenital anomaly registers in the world: historical and operational aspects

Objetivo: Identificar registros de anomalias congênitas com cobertura nacional existentes no mundo, destacando suas principais características históricas e operacionais. Métodos: Revisão documental, mediante busca na base Medline/Pubmed e consulta a dados provenientes de relatórios, documentos oficiais e sítios eletrônicos. Foram incluídos trabalhos com relato de pelo menos um registro nacional. Resultados: Foram identificados 40 registros nacionais de anomalias congênitas em 39 países diferentes. Todos os registros incluídos no estudo localizavam-se em países de renda alta ou média superior, com concentração na Europa. A maior parte dos registros foi de base populacional, de notificação compulsória e com tempo limite para notificação de até 1 ano de idade. O registro brasileiro apresentou a maior cobertura anual. Conclusão: Os registros discutidos apresentaram características diversas, relacionadas à realidade de cada país. Os resultados apresentados fornecem subsídios para a temática da vigilância das anomalias congênitas, sobretudo em locais onde se deseja implementar tal atividade.

Objetivo: Identificar registros de anomalías congénitas con cobertura nacional existentes en el mundo, destacando sus principales características históricas y operativas. Métodos: Revisión documental de literatura en la base de datos Medline/Pubmed y datos de informes, documentos oficiales y sitios web. Se incluyeron trabajos con informes de al menos un registro nacional. Resultados: Se identificaron 40 registros nacionales de anomalías congénitas en 39 países diferentes. Todos los registros incluidos se ubicaron en países de ingresos altos y medianos altos, con una concentración en Europa. La mayoría de los registros eran de base poblacional, con notificación obligatoria y un límite de tiempo de notificación de hasta 1 año. El registro brasileño presentá la cobertura anual más alta. Conclusión: Los registros discutidos presentaban características diferentes y relacionadas con la realidad de cada país. Los resultados presentados proporcionan subsidios para la vigilancia de anomalías congénitas, especialmente en lugares que deseen implementar dicha actividad.

Objective: To identify registers of congenital anomalies with national coverage currently available around the world, highlighting their main historical and operational characteristics. Methods: This was a documentary study by means of a Medline database search (via PubMed) and searches involving reports, official documents and websites. Studies reporting at least one national registry were included. Results: 40 registers of national congenital anomalies were identified in 39 different countries. All registers included in the study were concentrated in upper-middle or high-income countries located in Europe. Most of the registers were population-based, compulsory notification and with a time limit for notification of up to 1 year of age. The Brazilian register showed the highest annual coverage. Conclusion: The registers analyzed showed different characteristics, related to the reality of each country. The results presented provide support for the theme of congenital anomalies surveillance, especially in places where such activity is intended to be implemented.

Síndrome inflamatória multissistêmica pediátrica: estudo seccional dos casos e fatores associados aos óbitos durante a pandemia de COVID-19 no Brasil, 2020 / Multisystem inflammatory syndrome in children: a cross-sectional study of cases and factors associated with deaths during the COVID-19 pandemic in Brazil, 2020

Objetivo: Caracterizar o perfil clínico-epidemiológico da síndrome inflamatória multissistêmica pediátrica temporalmente associada à COVID-19 (SIM-P) e identificar fatores associados aos óbitos de SIM-P no Brasil, 2020. Métodos: Estudo seccional, utilizando dados do monitoramento nacional da SIM-P. Empregou-se regressão logística para estimar razões de chances (OR, odds ratios ) brutas e ajustadas. Resultados: Os casos (n=652) apresentaram mediana de idade de 5 anos; 57,1% eram do sexo masculino e 52,0% de raça/cor da pele parda; 6,4% evoluíram a óbito. A chance de óbito foi significativamente maior nos que apresentaram saturação de O2<95% (ORa=4,35 - IC95% 1,69;11,20) e resultado alterado de ureia (ORa=5,18 - IC95% 1,91;14,04); e menor na ausência de manchas vermelhas pelo corpo (ORa=0,23 - IC95% 0,09;0,62), com uso de anticoagulantes (ORa=0,32 - IC95% 0,12;0,89) e imunoglobulinas (ORa=0,38 - IC95% 0,15;1,01). Conclusão: A letalidade foi maior entre casos que apresentaram saturação de O2<95% e ureia alterada; e menor nos que apresentaram manchas vermelhas, usaram imunoglobulinas e anticoagulantes.

Objetivo: Caracterizar el perfil clínico-epidemiológico de los casos por síndrome inflamatorio multisistémico pediátrico asociado temporalmente a la COVID-19 (SIM-PedS) e identificar factores asociados a los óbitos por SIM-PedS en Brasil, 2020. Métodos: Estudio transversal basado en datos del monitoreo nacional de la SIM-PedS, Brasil, 2020. Se utilizó regresión logística para estimar razones de probabilidades brutas y ajustadas (OR, odds ratio). Resultados: Los casos (n=652) presentaron edad mediana de 5 años, 57,1% eran hombres, 52,0% de raza/color pardo y 6,4% falleció. La probabilidad de muerte fue significativamente mayor entre aquellos con saturación de O2<95% (ORa=4,35 - IC95%1,69;11,20) y resultado alterado de urea (ORa=5,18 - IC95% 1,91;14,04); menor en ausencia de manchas rojas como erupción (ORa=0,23 - IC95% 0,09;0,62), con uso de anticoagulantes (ORa=0,32 - IC95% 0,12;0,89) e inmunoglobulinas (ORa=0,38 - IC95%0,15;1,01). Conclusión: La letalidad fue mayor entre casos que presentaron saturación de O2<95% y urea alterada, y menor entre aquellos con manchas rojas, que usaron inmunoglobulinas y anticoagulantes.

Objective: To characterize the clinical-epidemiological profile of multisystem inflammatory syndrome in children temporally associated with COVID-19 (MIS-C), and to identify factors associated with MIS-C deaths in Brazil, 2020. Methods: This was a cross-sectional study, using national MIS-C monitoring data. Logistical regression was performed to estimate crude and adjusted odds ratios (OR). Results: Median case (n=652) age was 5 years, 57.1% were male, 52.0% were of brown race/skin color and 6.4% died. Likelihood of death was greater among those who presented O2 saturation <95% (ORa=4.35 - 95%CI 1.69;11.20) and altered urea results (ORa=5.18 - 95%CI 1.91;14.04); likelihood of death was lower when red skin blotches were not present (ORa=0.23 - 95%CI 0.09;0.62), when anticoagulants were used (ORa=0.32 - 95%CI 0.12;0.89) and when immunoglobulins were used (ORa=0.38 - 95%CI 0.15;1.01). Conclusion: Fatality ratios were higher among cases that presented O2 saturation <95% and altered urea results. Fatality ratios were lower among those with red skin blotches, and those who used immunoglobulins and anticoagulants.

Lista de anomalias congênitas prioritárias para vigilância no âmbito do Sistema de Informações sobre Nascidos Vivos do Brasil / Lista de anomalías congénitas prioritarias para la vigilancia bajo el Sistema de Información sobre Nacidos Vivos en Brasil / List of priority congenital anomalies for surveillance under the Brazilian Live Birth Information System

Objetivo: Definir a lista de anomalias congênitas prioritárias para o aprimoramento do registro no Sistema de Informações sobre Nascidos Vivos (Sinasc). Métodos: A partir da Décima Revisão da Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde (CID-10), protocolos internacionais e reuniões com especialistas, a lista de anomalias prioritárias foi construída considerando-se dois critérios principais: ser diagnosticável ao nascimento; e possuir intervenção disponível em diferentes níveis. A lista foi submetida a apreciação da Sociedade Brasileira de Genética Médica e Genômica. Resultados: Compuseram a lista oito grupos de anomalias congênitas distribuídos de acordo com o tipo de anomalia relacionada, bem como a parte do corpo afetada e sua correspondência ao código do capítulo XVII da CID-10. Conclusão: A lista de anomalias congênitas prioritárias para notificação fornece subsídios para o aprimoramento do registro no Sinasc.

Objetivo: Definir la lista de anomalías congénitas prioritarias para perfeccionar el registro en el Sistema de Información de Nacidos Vivos (Sinasc). Métodos: Con base en la Clasificación Internacional de Enfermedades, Décima Revisión (CIE-10), protocolos internacionales y reuniones con especialistas, la lista de anomalías prioritarias se construyó considerando dos criterios principales: ser diagnosticables al nacer y tener intervención disponible en diferentes niveles. La lista fue sometida a la consideración de la Sociedad Brasileña de Genética y Genómica Médica. Resultados: La lista comprendía ocho grupos de anomalías congénitas distribuidos según el tipo de anomalía relacionada, así como la parte del cuerpo afectada, todos ellos relacionados con algún código del capítulo XVII de la CIE-10. Conclusión: La lista de anomalías congénitas prioritarias para notificación proporciona subsidios para mejorar el registro en Sinasc.

Objective: To define the list of priority congenital anomalies for improving their recording on the Brazilian Live Birth Information System (Sinasc). Methods: Based on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), international protocols and meetings with specialists, the list of priority anomalies was built considering two main criteria: being diagnosable at birth and having intervention available at different levels. The list was submitted for consideration by the Brazilian Medical Genetics and Genomics Society. Results: The list comprised eight groups of congenital anomalies distributed according to the type of related anomaly, as well as the affected part of the body and its corresponding code in ICD-10 Chapter XVII. Conclusion: The list of priority congenital anomalies for notification provides a basis for improving case recording on Sinasc.

Congenital anomalies from the health surveillance perspective: compilation of a list based on ICD-10. / Anomalias congênitas na perspectiva da vigilância em saúde: compilação de uma lista com base na CID-10.

OBJECTIVE: To propose a list of congenital anomalies having corresponding codes in the International Statistical Classification of Diseases and Related Health Problems, 10thRevision (ICD-10), with the aim of applying it in health surveillance. METHODS: In December 2019, the following data sources were searched: ICD-10; ICD-11; anomalies monitored by three surveillance programs; and a database of rare diseases (Orphanet). Anomalies were retrieved from these data sources, processed to check for correspondence with ICD-10 and reviewed manually to compile the list. RESULTS: 898 codes were identified, of which 619 (68.9%) were contained in ICD-10 Chapter XVII. Of the 279 codes contained in other chapters, 19 were exclusive to the ICD-11 search, 72 to the surveillance programs, 79 to Orphanet and 36 to the search for terms in ICD-10. CONCLUSION: The codes contained in ICD-10 Chapter XVII do not capture the totality of congenital anomalies, indicating the need to adopt an expanded list.

International collaboration networks for the surveillance of congenital anomalies: a narrative review. / Redes internacionais de colaboração para a vigilância das anomalias congênitas: uma revisão narrativa.

Objective to identify international congenital anomaly surveillance collaboration networks, to list the programs that compose them and to compare their main characteristics. Methods this was a narrative literature review by means of a MEDLINE database search (via PubMed) and searches involving websites, reports and official documents. Results six international congenital anomaly surveillance collaboration networks were identified (ECLAMC, ICBDSR, EUROCAT, BINOCAR, SEAR-NBBD and ReLAMC), comprised of 98 programs present in 58 different countries on all continents, except Africa; the main characteristics regarding type of surveillance, coverage and location were discussed in a comparative manner. Conclusion international collaborative networks are important players for congenital anomaly surveillance, contributing to the understanding of the global epidemiological scenario of these conditions, in addition to acting both to strengthen individual existing programs and also to create surveillance initiatives in unassisted regions.

Anomalias congênitas na perspectiva da vigilância em saúde: compilação de uma lista com base na CID-10 / Anomalías congénitas desde la perspectiva de la vigilancia de la salud: compilación de una lista basada en la CIE-10 / Congenital anomalies from the health surveillance perspective: compilation of a list based on ICD-10

Objetivo: Propor uma lista de anomalias congênitas com códigos correspondentes na Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde - 10ᵃ Revisão (CID-10), visando a aplicação no âmbito da vigilância em saúde. Métodos: Em dezembro de 2019, realizou-se busca nas seguintes fontes de dados: CID-10; CID-11; anomalias monitoradas por três modelos de vigilância; base de informações sobre doenças raras (Orphanet). Realizou-se extração das anomalias a partir dessas fontes, processamento para correspondência com base na CID-10 e compilação mediante revisão manual. Resultados: Foram identificados 898 códigos, dos quais 619 (68,9%) constavam no capítulo XVII da CID-10. Dos 279 códigos de outros capítulos, 19 foram exclusivos da busca na CID-11, 72 dos modelos de vigilância, 79 da Orphanet e 36 da busca de termos na CID-10. Conclusão: Os códigos que constam do capítulo XVII da CID-10 não captam a totalidade das anomalias congênitas, indicando a necessidade de adoção de uma lista ampliada.

Objetivo: Proponer una lista de anomalías congénitas con códigos correspondientes en la décima revisión de la Clasificación Internacional de Enfermedades (CIE), con el objetivo de su aplicación en el ámbito de la vigilancia de la salud. Métodos: En diciembre de 2019, se buscaron las siguientes fuentes: CIE-10; CIE-11; anomalías monitoreadas por tres modelos de vigilancia; y base de informaciones sobre enfermedades raras (Orphanet). Las anomalías se extrajeron de estas fuentes de datos, se procesó en base a la CIE-10 y se compiló con una revisión manual. Resultados: Se identificaron 898 códigos, de los cuales 619 (68,9%) estaban en el Capítulo XVII de la CIE-10. De los 279 códigos en otros capítulos, 19 fueron exclusivos de la búsqueda en la CIE-11, 72 de los modelos de vigilancia, 79 de Orphanet y 36 de la búsqueda de términos en la CIE-10. Conclusión: Los códigos contenidos en el capítulo XVII de la CIE-10 no capturan la totalidad de las anomalías congénitas, lo que indica la necesidad de adoptar una lista ampliada.

Objective: To propose a list of congenital anomalies having corresponding codes in the International Statistical Classification of Diseases and Related Health Problems, 10thRevision (ICD-10), with the aim of applying it in health surveillance. Methods: In December 2019, the following data sources were searched: ICD-10; ICD-11; anomalies monitored by three surveillance programs; and a database of rare diseases (Orphanet). Anomalies were retrieved from these data sources, processed to check for correspondence with ICD-10 and reviewed manually to compile the list. Results: 898 codes were identified, of which 619 (68.9%) were contained in ICD-10 Chapter XVII. Of the 279 codes contained in other chapters, 19 were exclusive to the ICD-11 search, 72 to the surveillance programs, 79 to Orphanet and 36 to the search for terms in ICD-10. Conclusion: The codes contained in ICD-10 Chapter XVII do not capture the totality of congenital anomalies, indicating the need to adopt an expanded list.

Redes internacionais de colaboração para a vigilância das anomalias congênitas: uma revisão narrativa / Redes de colaboración internacional para la vigilancia de anomalías congénitas: una revisión narrativa / International collaboration networks for the surveillance of congenital anomalies: a narrative review

Objetivo: identificar as redes de colaboração internacional para vigilância das anomalias congênitas, elencar os programas que as compõem e comparar suas principais características. Métodos: revisão narrativa de literatura, mediante busca na base MEDLINE (via PubMed), em endereços on-line, relatórios e documentos oficiais. Resultados: foram identificadas seis redes de colaboração internacional para a vigilância de anomalias congênitas (ECLAMC, ICBDSR, EUROCAT, BINOCAR, SEAR-NBBD e ReLAMC), compostas por 98 programas presentes em 58 diferentes países de todos os continentes, exceto a África; as principais características quanto ao tipo de vigilância, cobertura e localização foram discutidas de modo comparativo. Conclusão: as redes colaborativas internacionais constituem importantes atores para a vigilância das anomalias congênitas, contribuindo com o entendimento do cenário epidemiológico global desses agravos, além de atuar tanto para o fortalecimento de programas individuais já existentes quanto para a criação de iniciativas de vigilância em regiões desassistidas.

Objetivo analizar la prevalencia de enfermedades respiratorias y diarrea en trabajadores de cooperativas de materiales reciclables en São Paulo, Brasil, y factores asociados. Métodos: estudio transversal en tres cooperativas, con datos recopilados por entrevistas estructuradas y medición de la concentración fungica ambiental; se usó la regresión de Poisson para estimar las razones de prevalencia (RP). Resultados: 156 personas fueron entrevistadas; la mayor prevalencia de asma, enfermedad pulmonar obstructiva crónica (EPOC) y diarrea se produjo en cooperativas con la mayor concentración fúngica total; se observó una mayor prevalencia ajustada de asma en la cooperativa A (RP=8,44 - IC95% 1,09;65,37) y diarrea en C (RP=2,09 - IC95% 1,11;3,94), en comparación con la cooperativa B; la mayor prevalencia de EPOC se observó en los fumadores y ex fumadores (RP=8,66 - IC95% 2,84;26,35). Conclusión: se deben adoptar medidas de control fúngica como prevención de enfermedades en cooperativas de materiales reciclables.

Objective: to identify international congenital anomaly surveillance collaboration networks, to list the programs that compose them and to compare their main characteristics. Methods: this was a narrative literature review by means of a MEDLINE database search (via PubMed) and searches involving websites, reports and official documents. Results: six international congenital anomaly surveillance collaboration networks were identified (ECLAMC, ICBDSR, EUROCAT, BINOCAR, SEAR-NBBD and ReLAMC), comprised of 98 programs present in 58 different countries on all continents, except Africa; the main characteristics regarding type of surveillance, coverage and location were discussed in a comparative manner. Conclusion: international collaborative networks are important players for congenital anomaly surveillance, contributing to the understanding of the global epidemiological scenario of these conditions, in addition to acting both to strengthen individual existing programs and also to create surveillance initiatives in unassisted regions.

Educational inequality in Rio de Janeiro and its impact on multimorbidity: evidence from the Pró-Saúde study. A cross-sectional analysis.

BACKGROUND: Information about multimorbidity is scarce in developing countries. This study aimed to estimate the association of educational attainment with occurrences of multimorbidity in a population of public employees on university campuses in Rio de Janeiro. DESIGN AND SETTING: We conducted cross-sectional analyses on baseline data (1999-2001) from 3,253 participants in the Pró-Saúde study, conducted in Brazil. METHODS: The prevalence of multimorbidity, defined as a self-reported history of medical diagnoses of two or more chronic conditions, was estimated according to sex, age, smoking, obesity and educational level. The association between education and multimorbidity was estimated using odds ratios (OR) and the relative and slope indices of inequality, in order to quantify the degree of educational inequality among individuals with multimorbidity in this population. RESULTS: Greater age, female sex, smoking and obesity had direct associations with multimorbidity; and tobacco exposure and obesity also showed direct relationships with poorer educational level. There was a monotonic inverse linear trend between educational level and the presence of multimorbidity among women, with twice the odds (OR 2.47; 95% confidence interval, CI: 1.42-4.40) between extremities of schooling categories. There was excess multimorbidity of 22% at the lowest extremity of schooling, thus showing that women with worse educational status were more affected by the outcome. No trend and no excess multimorbidity was seen among men. CONCLUSIONS: Educational inequality is an important determinant for development of multimorbidity. Men and women experience its effect differently. Researchers need to consider that sex may be an effect modifier in multimorbidity studies.

Educational inequality in Rio de Janeiro and its impact on multimorbidity: evidence from the Pró-Saúde study. A cross-sectional analysis

ABSTRACT BACKGROUND: Information about multimorbidity is scarce in developing countries. This study aimed to estimate the association of educational attainment with occurrences of multimorbidity in a population of public employees on university campuses in Rio de Janeiro. DESIGN AND SETTING: We conducted cross-sectional analyses on baseline data (1999-2001) from 3,253 participants in the Pró-Saúde study, conducted in Brazil. METHODS: The prevalence of multimorbidity, defined as a self-reported history of medical diagnoses of two or more chronic conditions, was estimated according to sex, age, smoking, obesity and educational level. The association between education and multimorbidity was estimated using odds ratios (OR) and the relative and slope indices of inequality, in order to quantify the degree of educational inequality among individuals with multimorbidity in this population. RESULTS: Greater age, female sex, smoking and obesity had direct associations with multimorbidity; and tobacco exposure and obesity also showed direct relationships with poorer educational level. There was a monotonic inverse linear trend between educational level and the presence of multimorbidity among women, with twice the odds (OR 2.47; 95% confidence interval, CI: 1.42-4.40) between extremities of schooling categories. There was excess multimorbidity of 22% at the lowest extremity of schooling, thus showing that women with worse educational status were more affected by the outcome. No trend and no excess multimorbidity was seen among men. CONCLUSIONS: Educational inequality is an important determinant for development of multimorbidity. Men and women experience its effect differently. Researchers need to consider that sex may be an effect modifier in multimorbidity studies.

Desigualdade social, interseccionalidade e hipertensão no Brasil contemporâneo / Social inequality, intersectionality, and hypertension in contemporary Brazil

Esta tese apresenta dois estudos principais que veiculam uma série de apreciações críticas para análise situacional das desigualdades em saúde. Primeiro, descreve-se uma revisão sistemática de escopo sobre a produção acadêmica e os métodos de estimação relacionados a duas medidas sumárias do gradiente socioeconômico na saúde: índice relativo de desigualdade (RII) e índice angular de desigualdade (SII). Foram incluídos 417 artigos que usaram o RII e/ou o SII em pesquisas originais, publicados em 136 periódicos entre 1985 e 2016, dos quais 45% resultaram de colaboração internacional entre 1267 pesquisadores de instituições de 60 países. 51% dos artigos usaram o RII, 13% o SII e 36% ambas as medidas. A tendência de usar ambas as medidas relativa e absoluta prevaleceu na literatura mais recente, atingindo 58% dos artigos publicados em 2016. Discutem-se cinco proposições centrais para a definição dos índices de desigualdade, identificadas por meio de um indicador descritivo, elaborado nesta tese ­ número de citações internas metodológicas. Segundo, apresenta-se um estudo seccional com dados da Pesquisa Nacional de Saúde (2013), onde o RII e o SII foram aplicados na mensuração das desigualdades na prevalência de hipertensão no Brasil, conforme estratos interseccionais de gênero, raça e escolaridade. A prevalência de hipertensão ajustada por idade foi 34% entre homens e 31% entre mulheres, mas a desigualdade de gênero foi evidente apenas entre indivíduos autodeclarados brancos ou pardos, com ensino médio completo ou superior. Diferenças raciais na prevalência de hipertensão foram observadas somente entre as mulheres, e essa desigualdade racial aumentou com o nível de escolaridade. Gradiente educacional na hipertensão foi restrito a mulheres autodeclaradas brancas (RII = 2.5; SII = 18%) ou pardas (RII = 2.3, SII = 14.5%), enquanto que a prevalência de hipertensão foi homogênea nos subgrupos de escolaridade entre as mulheres pretas e os homens de todos os estratos raciais. Esses resultados mostram uma série de detalhes contrastantes para o estabelecido padrão social da hipertensão, enfatizando a importância de examinar a reciprocidade entre múltiplas dimensões sociais na pesquisa sobre as desigualdades em saúde. O uso dos índices relativo e angular de desigualdade deve ser encorajado para o monitoramento das desigualdades em saúde em perspectiva interseccional.

This thesis presents two main studies that provide a series of critical appraisal for the situational analysis of health inequalities. The first one describes a systematic scoping review on the academic production and the estimation methods related to two summary measures of the socioeconomic gradient in health: relative index of inequality (RII) and slope index of inequality (SII). A total of 417 articles used the RII or the SII in original research, published in 136 journals between 1985 and 2016, in which 45% resulted of international collaboration among 1267 researchers from institutions of 60 countries. 51% of the articles used the RII, 13% the SII and 36% both measures. The trend of using both relative and absolute measures prevailed in the most recent literature, reaching 58% of articles published in 2016. I discuss five central proposals for the definition of inequality indices, which were identified by a descriptive indicator, elaborated in this thesis ­ the number of methodological internal citations. The second one presents a cross-sectional study with data obtained from the National Health Survey (2013), where the RII and the SII were applied for the measurement of inequalities in the prevalence of hypertension in Brazil, according to intersectional strata of gender, race, and education. The age-adjusted prevalence of hypertension was 34% among men and 31% among women, but gender inequality was evident only among white or brown people with high school education or higher. Racial differences in the prevalence of hypertension were observed only among women, and this racial inequality increased with education level. The educational gradient in hypertension was restricted to women self-identified as white (RII = 2.5; SII = 18%) or brown (RII = 2.3, SII = 14.5%), whereas the prevalence of hypertension was homogeneous across educational subgroups among black women and among men of all racial strata. These results show a number of contrasting details for the established social patterning of hypertension, and highlight the importance of examining reciprocity among multiple social dimensions in health inequalities research. The use of the relative index of inequality and the slope index of inequality should be encouraged for health inequalities monitoring in an intersectional perspective.

Educational inequalities in hypertension: complex patterns in intersections with gender and race in Brazil.

BACKGROUND: Hypertension is a major public health issue worldwide, but knowledge is scarce about its patterns and its relationship to multiple axes of social disadvantages in Latin American countries. This study describes the educational inequality in the prevalence of hypertension in Brazil, including a joint stratification by gender and race. METHODS: We analyzed interview-based data and blood pressure measurements from 59,402 participants aged 18 years or older at the 2013 Brazilian National Health Survey (PNS). Sociodemographic characteristics analyzed were gender (male, female), racial self-identification (white, brown, black), age (5-years intervals), and educational attainment (pre-primary, primary, secondary, tertiary). Hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg, and/or self-reported use of antihypertensive medications in the last 2 weeks. We used logistic regression to evaluate the age-adjusted prevalences of hypertension (via marginal modeling), and pair-wise associations between education level and odds of hypertension. Further, the educational inequality in hypertension was summarized through the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). All analyses considered the appropriate sampling weights and intersections with gender, race, and education. RESULTS: Age-adjusted prevalence of hypertension was 34.0 % and 30.8 % among men and women, respectively. Black and brown women had a higher prevalence than whites (34.5 % vs. 31.8 % vs. 29.5 %), whereas no racial differences were observed among men. White and brown, but not black women, showed graded inverse associations between hypertension and educational attainment; among men, non-statistically significant associations were observed in all racial strata. The RII and SII estimated inverse gradients among white (RII = 2.5, SII = 18.1 %) and brown women (RII = 2.3, SII = 14.5 %), and homogeneous distributions of hypertension in educational subgroups among black women and among men. CONCLUSION: In this representative sample of Brazilian adults, the association between educational attainment and hypertension was influenced by gender and race - a topic still poorly understood. Our findings highlight the importance of assessing intersections of multiple sociodemographic characteristics in health inequalities research. The use of comprehensive measures of inequality, such as RII and SII, provide useful insights for monitoring health inequalities in an intersectional perspective.

[Educational inequality in the occurrence of abdominal obesity according to gender and color/race: the Pro-Health Study, 1999-2001 and 2011-2012]. / Desigualdade educacional na ocorrência de obesidade abdominal por gênero e cor/raça: Estudo Pró-Saúde, 1999-2001 e 2011-2012.

Cross-sectional data from the Pro-Health Study in 1999-2001 and 2011-2012 revealed important gender and color/race differences in the size and variation across time in educational inequalities related to abdominal obesity. Probability of obesity increased steadily in women (independently of color/race) and men (brown/black) with less schooling. These gradients were quantified according to the relative index of inequality (RII). Over the course of the decade, there was a reduction in inequality in brown/black women (ΔRII: 0.5; 95%CI: 0.2-1.1), underlying a relatively higher increase in the prevalence of abdominal obesity in women with more schooling. RII was stable in white women and brown/black men, indicating a similar increase in the prevalence of abdominal obesity in educational subgroups. The association between schooling and abdominal obesity was affected by the multiple interaction of socio-demographic factors. Our results recommend joint stratification by gender and color/race in the study of socioeconomic inequalities related to abdominal obesity.