Survival inequalities in head and neck cancers: A hospital-based cohort study.

BACKGROUND: We investigated whether the socioeconomic status (SES) influenced survival rates in oropharynx cancers (OPC), oral cavity cancers (OCC), and larynx cancers (LC) in Brazilian patients. METHODS: This hospital-based cohort study assessed the age-standardized 5-year relative survival (RS) using the Pohar Perme estimator. RESULTS: Overall, we identified 37 191 cases, and 5-year RS were 24.4%, 34.1%, and 44.9% in OPC, OCC, and LC, respectively. In multiple Cox regression, the highest risk of death occurred in the most vulnerable social strata for all subsites-that is, illiterates or patients relying on publicly funded healthcare services. Disparities increased over time by 34.9% in OPC due to the rising of survival rates in the highest SES, whereas they reduced by 10.2% and 29.6% in OCC and LC. CONCLUSIONS: The potential inequities were more significant for OPC than for OCC and LC. It is urgent to tackle social disparities to improve prognoses in highly unequal countries.

Cancer inequalities in incidence and mortality in the State of São Paulo, Brazil 2001-17.

BACKGROUND: Cancer disparities exist between and within countries; we sought to compare cancer-specific incidence and mortality according to area-level socioeconomic status (SES) in the State of São Paulo, Brazil. METHODS: Cancer cases diagnosed 2003-2017 in the Barretos region and 2001-2015 in the municipality of São Paulo were obtained from the respective cancer registries. Corresponding cancer deaths were obtained from a Brazilian public government database. Age-standardized rates for all cancer combined and the six most common cancers were calculated by SES quartiles. RESULTS: There were 14,628 cancer cases and 7513 cancer deaths in Barretos, and 472,712 corresponding cases and 194,705 deaths in São Paulo. A clear SES-cancer gradient was seen in São Paulo, with rates varying from 188.4 to 333.1 in low to high SES areas, respectively. There was a lesser social gradient for mortality, with rates in low to high SES areas ranging from 86.4 to 98.0 in Barretos, and from 99.2 to 100.1 in São Paulo. The magnitude of the incidence rates rose markedly with increasing SES in São Paulo city for colorectal, lung, female breast, and prostate cancer. Conversely, both cervical cancer incidence and mortality rose with lower levels of SES in both regions. CONCLUSIONS: A clear SES association was seen for cancers of the prostate, female breast, colorectum, and lung for São Paulo. This study offers a better understanding of the cancer incidence and mortality profile according to SES within a highly populated Brazilian state.

Validity and reliability of the Brazilian version of the Johns Hopkins Fall Risk Assessment Tool to assess the risk of falls. / Validade e confiabilidade da versão brasileira da Johns Hopkins Fall Risk Assessment Tool para avaliação do risco de quedas.

OBJECTIVE: To evaluate the validity and reliability of the Johns Hopkins Fall Risk Assessment Tool (JH-FRAT), which assesses the risk of falls in hospitalized inpatients. METHOD: Study with 297 patients at a hospital in São Paulo, using retrospective data form 2014. Validity was assessed by accuracy (sensitivity, specificity, positive predictive value - PPV and negative predictive value - NPV) and discriminant analysis (comparison of patients with and without falls in relation to the scale items and comparison of previous risk situations in relation to the injury). The χ2 test and Fisher's exact test were used. Reliability was assessed by reproducibility between methods and interobserver test-retest comparison in a subsample of 60 patients. We used the Kappa, quadratic weighted Kappa and PABAK statistics. RESULTS: Sensitivity was 97.0%, specificity was 6%, PPV was 36.2% and NPV was 90.6%. Five of the eight items of the scale and the overall classification showed risk discrimination capability (p < 0.050). The risk of previous situations did not discriminate the injury resulting from the falls (p = 0.557). Reproducibility between methods was substantial (PABAK = 0.71). The interobserver reproducibility ranged between items (PABAK 0.25 to 1.00) and was substantial to the overall risk classification (PABAK = 0.71). CONCLUSION: JH-FRAT showed validity and reliability expected of a screening tool for risk of falls, and it can contribute to the implementation of fall management strategies in hospitals.

OBJETIVO: Avaliar a validade e a confiabilidade da escala Johns Hopkins Fall Risk Assessment Tool (JH-FRAT) para avaliação do risco de quedas em pacientes hospitalizados. MÉTODO: Estudo retroativo com 297 pacientes de um hospital privado de São Paulo usando dados de 2014. A validade foi avaliada por meio da acurácia (sensibilidade, especificidade, valores preditivos positivo - VPP e negativo - VPN), da validade de critério, verificando-se as associações entre a classificação do risco pelas escalas JH-FRAT e Morse, e da análise discriminante (comparação dos pacientes com e sem quedas em relação aos itens da escala e verificação de situações prévias de risco em relação ao dano ocorrido). Foram utilizados os testes de associação χ2. A confiabilidade foi avaliada por meio da reprodutibilidade teste-reteste interobservadores, usando as estatísticas Kappa ponderado quadrático e prevalence-adjusted and bias-adjusted Kappa (PABAK). RESULTADOS: A sensibilidade foi de 97,0%, a especificidade, 14,6%, o VPP, 36,2%, e o VPN, 90,6%. A análise de critério mostrou associação (p < 0,0001) entre as avaliações pelas duas escalas. Cinco dos oito itens da escala e a classificação geral mostraram capacidade de discriminação do risco (p < 0,050). A reprodutibilidade interobservadores variou entre itens (PABAK de 0,25 a 1,00) e foi substancial na classificação do risco global (PABAK = 0,71). CONCLUSÃO: A JH-FRAT apresentou validade e confiabilidade esperadas para um instrumento de triagem do risco de quedas, podendo contribuir na aplicação de estratégias para a gestão de quedas em hospitais.

Validade e confiabilidade da versão brasileira da Johns Hopkins Fall Risk Assessment Tool para avaliação do risco de quedas / Validity and reliability of the Brazilian version of the Johns Hopkins Fall Risk Assessment Tool to assess the risk of falls

RESUMO: Objetivo: Avaliar a validade e a confiabilidade da escala Johns Hopkins Fall Risk Assessment Tool (JH-FRAT) para avaliação do risco de quedas em pacientes hospitalizados. Método: Estudo retroativo com 297 pacientes de um hospital privado de São Paulo usando dados de 2014. A validade foi avaliada por meio da acurácia (sensibilidade, especificidade, valores preditivos positivo - VPP e negativo - VPN), da validade de critério, verificando-se as associações entre a classificação do risco pelas escalas JH-FRAT e Morse, e da análise discriminante (comparação dos pacientes com e sem quedas em relação aos itens da escala e verificação de situações prévias de risco em relação ao dano ocorrido). Foram utilizados os testes de associação χ2. A confiabilidade foi avaliada por meio da reprodutibilidade teste-reteste interobservadores, usando as estatísticas Kappa ponderado quadrático e prevalence-adjusted and bias-adjusted Kappa (PABAK). Resultados: A sensibilidade foi de 97,0%, a especificidade, 14,6%, o VPP, 36,2%, e o VPN, 90,6%. A análise de critério mostrou associação (p < 0,0001) entre as avaliações pelas duas escalas. Cinco dos oito itens da escala e a classificação geral mostraram capacidade de discriminação do risco (p < 0,050). A reprodutibilidade interobservadores variou entre itens (PABAK de 0,25 a 1,00) e foi substancial na classificação do risco global (PABAK = 0,71). Conclusão: A JH-FRAT apresentou validade e confiabilidade esperadas para um instrumento de triagem do risco de quedas, podendo contribuir na aplicação de estratégias para a gestão de quedas em hospitais.

ABSTRACT: Objective: To evaluate the validity and reliability of the Johns Hopkins Fall Risk Assessment Tool (JH-FRAT), which assesses the risk of falls in hospitalized inpatients. Method: Study with 297 patients at a hospital in São Paulo, using retrospective data form 2014. Validity was assessed by accuracy (sensitivity, specificity, positive predictive value - PPV and negative predictive value - NPV) and discriminant analysis (comparison of patients with and without falls in relation to the scale items and comparison of previous risk situations in relation to the injury). The χ2 test and Fisher's exact test were used. Reliability was assessed by reproducibility between methods and interobserver test-retest comparison in a subsample of 60 patients. We used the Kappa, quadratic weighted Kappa and PABAK statistics. Results: Sensitivity was 97.0%, specificity was 6%, PPV was 36.2% and NPV was 90.6%. Five of the eight items of the scale and the overall classification showed risk discrimination capability (p < 0.050). The risk of previous situations did not discriminate the injury resulting from the falls (p = 0.557). Reproducibility between methods was substantial (PABAK = 0.71). The interobserver reproducibility ranged between items (PABAK 0.25 to 1.00) and was substantial to the overall risk classification (PABAK = 0.71). Conclusion: JH-FRAT showed validity and reliability expected of a screening tool for risk of falls, and it can contribute to the implementation of fall management strategies in hospitals.

Disparities in colorectal cancer mortality across Brazilian States. / Disparidades na mortalidade de câncer colorretal nos estados brasileiros.

OBJECTIVE: To analyze the trend of colorectal cancer mortality adjusted for selected indicators, according to sex, by Brazilian federative units and regions, and countrywide from 1996 to 2012. METHODS: This is a temporal time series on colorectal cancer mortality rates, using linear regression analysis, in which the independent variable was the centered year. Models were adjusted for selected indicators. RESULTS: There was an increase in standardized colorectal cancer mortality rates for males in all states and for females in 21 states. In the model adjusted for mortality rate from ill-defined causes, for gross domestic product, and for Gini coefficient, the upward trend remained statistically significant (p < 0.05) countrywide only for men, with 0.17 deaths per 100 thousand inhabitants per year (py). In the States of Piauí (0.09 and 0.20 py), Ceará (0.17 and 0.19 py) and Rio Grande do Sul (0.61 and 0.42 py), there was an increase for both men and women, respectively; only among men in the States of Paraíba (0.16 py), Espírito Santo (0.28 py), São Paulo (0.24 py) and Goiás (0.31 py); and among women in Roraima (0.41 py), Amapá (0.97 P/Y), Maranhão (0.10 py), Sergipe (0.46 P/Y), Mato Grosso do Sul (0.47 py), and the Federal District (0.69 py). CONCLUSION: The increase in colorectal cancer mortality remained significant when assessing Brazil as a whole only among men; in seven States among men, and in nine States among women, regardless of the studied indicators. These differences could be related to the possible increase in incidence and to late access to diagnosis and treatment.

OBJETIVO: Analisar a tendência da mortalidade por câncer colorretal, ajustado por indicadores selecionados, segundo sexo, para unidades federativas, regiões e Brasil, no período de 1996 a 2012. MÉTODOS: Estudo ecológico de série temporal das taxas de mortalidade por câncer colorretal, feita análise de regressão linear, sendo o ano centralizado a variável independente. Os modelos foram ajustados por indicadores selecionados. RESULTADOS: Houve aumento nas taxas de mortalidade padronizadas por câncer colorretal em todos os estados para o sexo masculino e em 21 estados para o sexo feminino. No modelo ajustado por taxa de mortalidade por causas mal definidas, produto interno bruto e coeficiente de Gini, a tendência de aumento foi significativa (p < 0,05) no Brasil, somente para os homens, com 0,17 óbitos por 100 mil habitantes ao ano (aa). Nos estados do Piauí (0,09 e 0,20 aa), Ceará (0,17 e 0,19 aa) e Rio Grande do Sul (0,61 e 0,42 aa) ocorreu aumento em homens e mulheres, respectivamente; somente em homens nos estados da Paraíba (0,16 aa), no Espírito Santo (0,28 aa), em São Paulo (0,24 aa) e Goiás (0,31 aa); e em mulheres nos estados de Roraima (0,41 aa), do Amapá (0,97 aa), Maranhão (0,10 aa), Sergipe (0,46 aa), Mato Grosso do Sul (0,47 aa) e Distrito Federal (0,69 aa). CONCLUSÃO: O aumento da taxa de mortalidade por câncer colorretal manteve-se significativo no Brasil somente entre os homens; em sete estados, entre homens; e em nove estados, entre mulheres, independentemente dos indicadores estudados. Essas diferenças podem estar relacionadas ao possível aumento da incidência e ao acesso tardio ao diagnóstico e tratamento.

Relationships between parent feeding behaviors and parent and child characteristics in Brazilian preschoolers: a cross-sectional study.

BACKGROUND: Eating habits formed in early childhood are influenced by parental feeding behaviors, warranting investigation of predictors and correlates of parent feeding. We aimed to describe relationships between parental feeding practices and parent and child characteristics in a sample of Brazilian preschoolers. METHODS: Four hundred and two parents of preschoolers enrolled in private schools of São Paulo and Campinas, Brazil, completed a Brazilian version of the Comprehensive Feeding Practices Questionnaire, as well as questions about parental attitudes, child food intake, other obesity-associated behaviors, and socioeconomic and demographic characteristics. We ran bivariate logistic regression models examining associations between independent variables and each feeding practice. Next, we ran multiple logistic regression models predicting each parental feeding practice. RESULTS: Greater 'Restriction for Weight Control' and 'Restriction for Health' were associated with lower maternal education (OR = 2.42 (CI 95% 1.07-5.48) and 2.79 (CI 95% 1.25-6.22), respectively), and with higher concern about child overweight (OR = 2.46, CI 95% 1.64-3.69 for 'Restriction for Weight Control', only), while greater 'Pressure' was associated with greater concern about child underweight (OR = 2.30, CI 95% 1.53-3.47) and lower maternal BMI (OR = 0.94, CI 95% 0.88-1.00). Greater use of 'Emotion Regulation/ Food as Reward' was associated with lower maternal education (OR = 2.22, CI 95% 1.05-4.71). In analyses of positive feeding practices, lesser use of 'Healthy Eating Guidance' and 'Monitoring' was associated with greater intake of less healthy foods in children (OR = 1.53 (CI 95% 1.01-2.32) and OR = 1.94 (CI 95% 1.27-2.97), respectively), and greater use of screen devices (OR = 1.59 (CI 95% 1.04-2.44) and OR = 1.57 (CI 95% 1.03-2.39), respectively). Lesser use of 'Healthy Eating Guidance' was additionally associated with higher maternal BMI (OR = 1.09, CI 95% 1.03-1.16), and lesser use of 'Monitoring' with lesser perceived parent responsibility for child feeding (OR = 1.68, CI 95% 1.12-2.52). CONCLUSIONS: Our results demonstrate diverse socioeconomic, anthropometric and behavioral correlates of parent feeding in a large Brazilian sample of parents of preschoolers.

Sociodemographic, anthropometric and behavioural risk factors for ultra-processed food consumption in a sample of 2-9-year-olds in Brazil.

OBJECTIVE: The present study aimed to identify food patterns among 2-9-year-olds and investigate sociodemographic, anthropometric and behavioural predictors of less healthy dietary patterns. DESIGN: Cross-sectional study. Parents of 2-9-year-olds completed an FFQ and factor analysis was applied to identify dietary patterns. Parents also completed questionnaires assessing sociodemographic, anthropometric and behavioural characteristics of parents and children, including parental feeding practices. SETTING: Participants were recruited from private schools of Campinas and São Paulo, SP, Brazil, between April and June 2014. SUBJECTS: Parents of 2-9-year-olds (n 929). RESULTS: Two dietary patterns emerged: 'traditional food' and 'ultra-processed food'. Lower maternal education (OR=2·05, P=0·010) and higher maternal weight status (OR=1·43, P=0·044) were associated with a greater likelihood of the ultra-processed food pattern. Lower perceived parental responsibility for adequacy of food group intake (OR=2·41, P=0·020), and lower scores on the parental feeding practices of 'Healthy Eating Guidance' (OR=1·83, P<0·001) and 'Monitoring' (OR=2·52, P<0·001), were also associated with the presence of this pattern, as was higher child's screen use during mealtimes (OR=1·61, P=0·004). CONCLUSIONS: The present study is the first to evaluate associations between less healthy dietary patterns of Brazilian 2-9-year-olds and parental feeding practices. Our findings highlight sociodemographic, anthropometric and behavioural factors within families that could be used to target tailored policies to at-risk populations.

Disparidades na mortalidade de câncer colorretal nos estados brasileiros / Disparities in colorectal cancer mortality across Brazilian States

RESUMO: Objetivo: Analisar a tendência da mortalidade por câncer colorretal, ajustado por indicadores selecionados, segundo sexo, para unidades federativas, regiões e Brasil, no período de 1996 a 2012. Métodos: Estudo ecológico de série temporal das taxas de mortalidade por câncer colorretal, feita análise de regressão linear, sendo o ano centralizado a variável independente. Os modelos foram ajustados por indicadores selecionados. Resultados: Houve aumento nas taxas de mortalidade padronizadas por câncer colorretal em todos os estados para o sexo masculino e em 21 estados para o sexo feminino. No modelo ajustado por taxa de mortalidade por causas mal definidas, produto interno bruto e coeficiente de Gini, a tendência de aumento foi significativa (p < 0,05) no Brasil, somente para os homens, com 0,17 óbitos por 100 mil habitantes ao ano (aa). Nos estados do Piauí (0,09 e 0,20 aa), Ceará (0,17 e 0,19 aa) e Rio Grande do Sul (0,61 e 0,42 aa) ocorreu aumento em homens e mulheres, respectivamente; somente em homens nos estados da Paraíba (0,16 aa), no Espírito Santo (0,28 aa), em São Paulo (0,24 aa) e Goiás (0,31 aa); e em mulheres nos estados de Roraima (0,41 aa), do Amapá (0,97 aa), Maranhão (0,10 aa), Sergipe (0,46 aa), Mato Grosso do Sul (0,47 aa) e Distrito Federal (0,69 aa). Conclusão: O aumento da taxa de mortalidade por câncer colorretal manteve-se significativo no Brasil somente entre os homens; em sete estados, entre homens; e em nove estados, entre mulheres, independentemente dos indicadores estudados. Essas diferenças podem estar relacionadas ao possível aumento da incidência e ao acesso tardio ao diagnóstico e tratamento.

ABSTRACT: Objective: To analyze the trend of colorectal cancer mortality adjusted for selected indicators, according to sex, by Brazilian federative units and regions, and countrywide from 1996 to 2012. Methods: This is a temporal time series on colorectal cancer mortality rates, using linear regression analysis, in which the independent variable was the centered year. Models were adjusted for selected indicators. Results: There was an increase in standardized colorectal cancer mortality rates for males in all states and for females in 21 states. In the model adjusted for mortality rate from ill-defined causes, for gross domestic product, and for Gini coefficient, the upward trend remained statistically significant (p < 0.05) countrywide only for men, with 0.17 deaths per 100 thousand inhabitants per year (py). In the States of Piauí (0.09 and 0.20 py), Ceará (0.17 and 0.19 py) and Rio Grande do Sul (0.61 and 0.42 py), there was an increase for both men and women, respectively; only among men in the States of Paraíba (0.16 py), Espírito Santo (0.28 py), São Paulo (0.24 py) and Goiás (0.31 py); and among women in Roraima (0.41 py), Amapá (0.97 P/Y), Maranhão (0.10 py), Sergipe (0.46 P/Y), Mato Grosso do Sul (0.47 py), and the Federal District (0.69 py). Conclusion: The increase in colorectal cancer mortality remained significant when assessing Brazil as a whole only among men; in seven States among men, and in nine States among women, regardless of the studied indicators. These differences could be related to the possible increase in incidence and to late access to diagnosis and treatment.

Caesarean birth rates in public and privately funded hospitals: a cross-sectional study.

OBJECTIVE: To examine maternal and obstetric factors influencing births by cesarean section according to health care funding. METHODS: A cross-sectional study with data from Southeastern Brazil. Caesarean section births from February 2011 to July 2012 were included. Data were obtained from interviews with women whose care was publicly or privately funded, and from their obstetric and neonatal records. Univariate and multivariate analyses were conducted to generate crude and adjusted odds ratios (OR) with 95% confidence intervals (95%CI) for caesarean section births. RESULTS: The overall caesarean section rate was 53% among 9,828 women for whom data were available, with the highest rates among women whose maternity care was privately funded. Reasons for performing a c-section were infrequently documented in women's maternity records. The variables that increased the likelihood of c-section regardless of health care funding were the following: paid employment, previous c-section, primiparity, antenatal and labor complications. Older maternal age, university education, and higher socioeconomic status were only associated with c-section in the public system. CONCLUSIONS: Higher maternal socioeconomic status was associated with greater likelihood of a caesarean section birth in publicly funded settings, but not in the private sector, where funding source alone determined the mode of birth rather than maternal or obstetric characteristics. Maternal socioeconomic status and private healthcare funding continue to drive high rates of caesarean section births in Brazil, with women who have a higher socioeconomic status more likely to have a caesarean section birth in all birth settings.

Assessment of the effectiveness of physical activity interventions in the Brazilian Unified Health System.

OBJECTIVE: To assess the effect of interventions on the levels of physical activity of healthy adults, users of the Brazilian Unified Health System and attended by the Family Health Strategy. METHODS: Non-randomized experimental study with 157 adults allocated in three groups: 1) physical exercise classes (n = 54), 2) health education (n = 54), 3) control (n = 49). The study lasted for18 months, with 12 months of interventions and six months of follow-up after intervention. Assessments took place at the beginning, in the 12 months, and in the 18 months of study. Physical activity has been assessed by questionnaires and accelerometry. For the analyses, we have used the intention-to-treat principle and generalized estimating equations. RESULTS: After 12 months, both intervention groups have increased the minutes of weekly leisure time physical activity and annual scores of physical exercise, leisure and transport-related physical activity. The exercise class group has obtained the highest average annual physical exercises score when compared to the other groups (p < 0.001). In the follow-up period, the exercise class group reduced its annual score (average: -0.3; 95%CI -0.5--0.1), while the health education group increased this score (average: 0.2; 95%CI 0.1-0.4). There have been no differences in the levels of physical activity measured by accelerometry. CONCLUSIONS: The interventions have been effective in increasing the practice of physical activity. However, we have observed that the health education intervention was more effective for maintaining the practice of physical activity in the period after intervention. We recommend the use of both interventions to promote physical activity in the Brazilian Unified Health System, according to the local reality of professionals, facilities, and team objectives. OBJETIVO: Avaliar o efeito de intervenções nos níveis de atividade física de adultos saudáveis, usuários do Sistema Único de Saúde e atendidos pela Estratégia de Saúde da Família. MÉTODOS: Estudo experimental, não randomizado, com 157 adultos alocados em três grupos: 1) classes de exercícios físicos (n = 54); 2) educação em saúde (n = 54); 3) controle (n = 49). O estudo teve duração de 18 meses, sendo 12 meses de intervenções e seis meses de acompanhamento pós-intervenção. As avaliações ocorreram no início, nos 12 e nos 18 meses de estudo. A atividade física foi avaliada por questionários e por acelerometria. Para as análises, utilizaram-se o princípio de intenção de tratar e equações de estimativas generalizadas. RESULTADOS: Após 12 meses, ambos os grupos de intervenção aumentaram os minutos semanais de atividade física no lazer e os escores anuais de exercícios físicos, de lazer e de deslocamento. O grupo das classes de exercícios físicos obteve maior média de escore anual de exercícios físicos em comparação com os outros grupos (p < 0,001). No período pós-intervenção, o grupo de classes de exercícios físicos reduziu o escore anual de exercícios físicos (média: -0,3; IC95% -0,5--0,1), enquanto o grupo de educação em saúde aumentou este escore (média: 0,2; IC95% 0,1-0,4). Não houve diferenças nos níveis de atividade física mensurados por acelerometria. CONCLUSÕES: As intervenções foram efetivas para aumentar a prática de atividade física. No entanto, observou-se que a intervenção de educação em saúde foi mais efetiva para a manutenção da prática de atividade física no período pós-intervenção. Recomenda-se a utilização de ambas as intervenções para a promoção da atividade física no Sistema Único de Saúde, de acordo com as realidades locais de profissionais, instalações e objetivos das equipes.

Family vulnerability index to disability and dependence (FVI-DD), by social and health conditions. / Índice de vulnerabilidade a incapacidades e dependência (IVF-ID), segundo condições sociais e de saúde.

The Family Vulnerability Index to Disability and Dependence (FVI-DD) aims to summarize the dimensions of vulnerability to disability and dependence using family data monitored by Family Health Strategy (ESF) teams. This study aims to analyze the FVI-DD according to the social and health vulnerability, to validate and extract a cutoff point for each dimension. The FVI-DD was built with a sample of 248 families living in a region of São Paulo. The dimension related to health conditions was validated with good internal consistency, with respect to the Katz Index and the Lawton Scale, whereas the dimension related to social conditions was only validated in relation to Lawton Scale. Thus, a vulnerable family was defined as one with 15 or more points in the Total FVI-DD, and a vulnerable family in health conditions that with a score of 6 or more points in that dimension. Therefore, it is possible to classify families as not vulnerable, vulnerable in the social aspects, vulnerable in the health aspects and the more vulnerable family (social and health) using social indicators of empowerment and wear and health indicators related not only to the biological sphere, but also in the access to health services, health self-assessment and existing vulnerable groups.

Índice de vulnerabilidade a incapacidades e dependência (IVF-ID), segundo condições sociais e de saúde / Family vulnerability index to disability and dependence (FVI-DD), by social and health conditions

Resumo O Índice de Vulnerabilidade de Famílias a Incapacidade e Dependência (IVF-ID) tem a finalidade de sintetizar as dimensões de vulnerabilidade a incapacidade e dependência utilizando dados de famílias acompanhadas por equipes da Estratégia Saúde da Família (ESF). O objetivo deste estudo é analisar o IVF-ID, segundo a vulnerabilidade social e de saúde, para validar e extrair um ponto de corte para cada dimensão. O IVF-ID foi construído com uma amostra de 248 famílias residentes em uma região de São Paulo. A dimensão relacionada às condições de saúde foi validado com boa consistência interna, em relação ao Índice de Katz e à Escala de Lawton, enquanto a dimensão relacionada às condições sociais validou apenas em relação à Escala de Lawton. Assim, definiu-se como família vulnerável aquela com 15 ou mais pontos no IVF-ID Total e como família vulnerável nas condições de saúde aquela com 6 ou mais pontos nessa dimensão. Com isso, é possível classificar as famílias como não vulnerável, vulnerável nos aspectos sociais, vulnerável nos aspectos de saúde e família mais vulnerável, utilizando indicadores sociais, de fortalecimento e desgaste, e indicadores de saúde relacionados não apenas na esfera biológica, mas também no acesso a serviços de saúde, autoavaliação de saúde e presença de grupos vulneráveis.

Abstract The Family Vulnerability Index to Disability and Dependence (FVI-DD) aims to summarize the dimensions of vulnerability to disability and dependence using family data monitored by Family Health Strategy (ESF) teams. This study aims to analyze the FVI-DD according to the social and health vulnerability, to validate and extract a cutoff point for each dimension. The FVI-DD was built with a sample of 248 families living in a region of São Paulo. The dimension related to health conditions was validated with good internal consistency, with respect to the Katz Index and the Lawton Scale, whereas the dimension related to social conditions was only validated in relation to Lawton Scale. Thus, a vulnerable family was defined as one with 15 or more points in the Total FVI-DD, and a vulnerable family in health conditions that with a score of 6 or more points in that dimension. Therefore, it is possible to classify families as not vulnerable, vulnerable in the social aspects, vulnerable in the health aspects and the more vulnerable family (social and health) using social indicators of empowerment and wear and health indicators related not only to the biological sphere, but also in the access to health services, health self-assessment and existing vulnerable groups.

Assessment of the effectiveness of physical activity interventions in the Brazilian Unified Health System / Avaliação da efetividade de intervenções de promoção da atividade física no Sistema Único de Saúde

ABSTRACT OBJECTIVE To assess the effect of interventions on the levels of physical activity of healthy adults, users of the Brazilian Unified Health System and attended by the Family Health Strategy. METHODS Non-randomized experimental study with 157 adults allocated in three groups: 1) physical exercise classes (n = 54), 2) health education (n = 54), 3) control (n = 49). The study lasted for18 months, with 12 months of interventions and six months of follow-up after intervention. Assessments took place at the beginning, in the 12 months, and in the 18 months of study. Physical activity has been assessed by questionnaires and accelerometry. For the analyses, we have used the intention-to-treat principle and generalized estimating equations. RESULTS After 12 months, both intervention groups have increased the minutes of weekly leisure time physical activity and annual scores of physical exercise, leisure and transport-related physical activity. The exercise class group has obtained the highest average annual physical exercises score when compared to the other groups (p < 0.001). In the follow-up period, the exercise class group reduced its annual score (average: -0.3; 95%CI -0.5--0.1), while the health education group increased this score (average: 0.2; 95%CI 0.1-0.4). There have been no differences in the levels of physical activity measured by accelerometry. CONCLUSIONS The interventions have been effective in increasing the practice of physical activity. However, we have observed that the health education intervention was more effective for maintaining the practice of physical activity in the period after intervention. We recommend the use of both interventions to promote physical activity in the Brazilian Unified Health System, according to the local reality of professionals, facilities, and team objectives.

RESUMO OBJETIVO Avaliar o efeito de intervenções nos níveis de atividade física de adultos saudáveis, usuários do Sistema Único de Saúde e atendidos pela Estratégia de Saúde da Família. MÉTODOS Estudo experimental, não randomizado, com 157 adultos alocados em três grupos: 1) classes de exercícios físicos (n = 54); 2) educação em saúde (n = 54); 3) controle (n = 49). O estudo teve duração de 18 meses, sendo 12 meses de intervenções e seis meses de acompanhamento pós-intervenção. As avaliações ocorreram no início, nos 12 e nos 18 meses de estudo. A atividade física foi avaliada por questionários e por acelerometria. Para as análises, utilizaram-se o princípio de intenção de tratar e equações de estimativas generalizadas. RESULTADOS Após 12 meses, ambos os grupos de intervenção aumentaram os minutos semanais de atividade física no lazer e os escores anuais de exercícios físicos, de lazer e de deslocamento. O grupo das classes de exercícios físicos obteve maior média de escore anual de exercícios físicos em comparação com os outros grupos (p < 0,001). No período pós-intervenção, o grupo de classes de exercícios físicos reduziu o escore anual de exercícios físicos (média: -0,3; IC95% -0,5--0,1), enquanto o grupo de educação em saúde aumentou este escore (média: 0,2; IC95% 0,1-0,4). Não houve diferenças nos níveis de atividade física mensurados por acelerometria. CONCLUSÕES As intervenções foram efetivas para aumentar a prática de atividade física. No entanto, observou-se que a intervenção de educação em saúde foi mais efetiva para a manutenção da prática de atividade física no período pós-intervenção. Recomenda-se a utilização de ambas as intervenções para a promoção da atividade física no Sistema Único de Saúde, de acordo com as realidades locais de profissionais, instalações e objetivos das equipes.

Caesarean birth rates in public and privately funded hospitals: a cross-sectional study

ABSTRACT OBJECTIVE To examine maternal and obstetric factors influencing births by cesarean section according to health care funding. METHODS A cross-sectional study with data from Southeastern Brazil. Caesarean section births from February 2011 to July 2012 were included. Data were obtained from interviews with women whose care was publicly or privately funded, and from their obstetric and neonatal records. Univariate and multivariate analyses were conducted to generate crude and adjusted odds ratios (OR) with 95% confidence intervals (95%CI) for caesarean section births. RESULTS The overall caesarean section rate was 53% among 9,828 women for whom data were available, with the highest rates among women whose maternity care was privately funded. Reasons for performing a c-section were infrequently documented in women's maternity records. The variables that increased the likelihood of c-section regardless of health care funding were the following: paid employment, previous c-section, primiparity, antenatal and labor complications. Older maternal age, university education, and higher socioeconomic status were only associated with c-section in the public system. CONCLUSIONS Higher maternal socioeconomic status was associated with greater likelihood of a caesarean section birth in publicly funded settings, but not in the private sector, where funding source alone determined the mode of birth rather than maternal or obstetric characteristics. Maternal socioeconomic status and private healthcare funding continue to drive high rates of caesarean section births in Brazil, with women who have a higher socioeconomic status more likely to have a caesarean section birth in all birth settings.

Transcultural adaptation of the Johns Hopkins Fall Risk Assessment Tool.

OBJECTIVE: to perform the transcultural adaptation and content validity analysis of the Johns Hopkins Fall Risk Assessment Tool to assess both fall risk and fall-related injury risk for hospitalized elderly in Brazil. METHOD: the transcultural adaptation consisted of translating the scale to Portuguese (Brazil), back-translating it into its language of origin, establishing a consensus version, and having an expert committee verify its transcultural equivalence. Content assessment was conducted by a committee of judges, ending with the calculation of the items and scales' content validity index. Nurses tested the tool. RESULTS: the scale's translated version went through two evaluation rounds by the judges, based on which, the items with unsatisfactory performance were changed. The content validity index for the items was ≥80.0% and the global index 97.1%. The experimental application showed the scale is user-friendly. CONCLUSION: the scale presents valid content for the assessment of fall risk and risk of fall-related injuries and is easy to use, with the potential to contribute to the proper identification of risks and the establishment of care actions.

Evolution of hospital spending with drug-related psychiatric hospital admissions. / Evolução dos gastos hospitalares com internações psiquiátricas por drogas.

OBJECTIVE: To analyse the trend of expenditure on drug-related psychiatric hospital admissions in Maringá, Paraná, Brazil, from 1999 to 2012. METHOD: Ecological time series research with secondary data from the hospital information system of the unified health system ("SIH-SUS"). The records of admissions with a main diagnosis of drug abuse were used to calculate average expenditure. Chapter V of the ICD-10 was used to classify the most frequent diagnoses, namely abuse of alcohol, cannabis, cocaine, and psychoactive substances. The trend was expressed using a polynomial regression model. RESULTS: Average expenditure showed an increasing trend for cocaine and other psychoactive substances, and a decreasing trend for cannabis. Average expenditure for illicit drugs increased significantly. CONCLUSION: The scarcity of economic studies on this subject calls for national studies that address expenditure with drug-related hospital admission to promote the implementation of a psychosocial, outpatient and hospital care network in accord with public healthcare expenditure.

Evolução dos gastos hospitalares com internações psiquiátricas por drogas / Evolución de gastos con ingresos hospitalarios de psiquiatría por drogas / Evolution of hospital spending with drug-related psychiatric hospital admissions

RESUMO Objetivo Analisar a tendência dos gastos com internações hospitalares psiquiátricas por drogas no município de Maringá-PR, no período de 1999 a 2012. Método Estudo ecológico, de séries temporais, com dados secundários do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS). Foram calculados os gastos médios mais frequentes por diagnóstico principal de internação por drogas do Capítulo Cinco da CID-10: álcool; maconha; cocaína e substâncias psicoativas. Utilizou-se o modelo de tendência de regressão polinomial. Resultados Houve tendência de aumento no gasto médio por cocaína e de outras substâncias psicoativas e tendência decrescente nos gastos médios por maconha. Os gastos médios apresentaram aumento significativo por drogas ilícitas. Conclusões Estudos econômicos apresentam-se incipientes, sendo oportunas pesquisas nacionais que abordem os gastos com internações por drogas com a finalidade de promover subsídios para a implantação e implementação da rede de atenção psicossocial, ambulatorial e hospitalar em consonância com o gasto público em saúde.

RESUMEN Objetivo Analizar la tendencia del gasto en los ingresos hospitalarios psiquiátricos para las drogas en Maringá-PR, 1999-2012. Método Estudio ecológico de series temporales con datos secundarios del Sistema Información Hospitalaria del Sistema Único de Salud (SIH-SUS). Calculado el gasto promedio por diagnóstico de ingreso primario de drogas en Capítulo Cinco de CID-10 fueron frecuentes: alcohol; marihuana; cocaína y sustancias psicoactivas. Se utilizó modelo de tendencia de regresión polinómica. Resultados El aumento de la tendencia en el gasto promedio de la cocaína y otras sustancias psicoactivas y la tendencia a la baja en el gasto por marihuana. El gasto mostró aumento significativo de las drogas ilícitas. Conclusión Los estudios económicos se presentan incipientes siendo la investigación nacional oportuna sobre gastos de hospitalización de drogas con propósito de promover subsidios para el establecimiento y la aplicación de la atención psicosocial, ambulatorial y hospital de la red, en línea con el gasto público en salud.

ABSTRACT Objective To analyse the trend of expenditure on drug-related psychiatric hospital admissions in Maringá, Paraná, Brazil, from 1999 to 2012. Method Ecological time series research with secondary data from the hospital information system of the unified health system (“SIH-SUS”). The records of admissions with a main diagnosis of drug abuse were used to calculate average expenditure. Chapter V of the ICD-10 was used to classify the most frequent diagnoses, namely abuse of alcohol, cannabis, cocaine, and psychoactive substances. The trend was expressed using a polynomial regression model. Results Average expenditure showed an increasing trend for cocaine and other psychoactive substances, and a decreasing trend for cannabis. Average expenditure for illicit drugs increased significantly. Conclusion The scarcity of economic studies on this subject calls for national studies that address expenditure with drug-related hospital admission to promote the implementation of a psychosocial, outpatient and hospital care network in accord with public healthcare expenditure.

Transcultural adaptation of the Johns Hopkins Fall Risk Assessment Tool / Adaptação transcultural da Johns Hopkins Fall Risk Assessment Tool para avaliação do risco de quedas / Adaptación transcultural de la Johns Hopkins Fall Risk Assessment Tool para evaluación del riesgo de caídas

ABSTRACT Objective: to perform the transcultural adaptation and content validity analysis of the Johns Hopkins Fall Risk Assessment Tool to assess both fall risk and fall-related injury risk for hospitalized elderly in Brazil. Method: the transcultural adaptation consisted of translating the scale to Portuguese (Brazil), back-translating it into its language of origin, establishing a consensus version, and having an expert committee verify its transcultural equivalence. Content assessment was conducted by a committee of judges, ending with the calculation of the items and scales' content validity index. Nurses tested the tool. Results: the scale's translated version went through two evaluation rounds by the judges, based on which, the items with unsatisfactory performance were changed. The content validity index for the items was ≥80.0% and the global index 97.1%. The experimental application showed the scale is user-friendly. Conclusion: the scale presents valid content for the assessment of fall risk and risk of fall-related injuries and is easy to use, with the potential to contribute to the proper identification of risks and the establishment of care actions.

RESUMO Objetivo: realizar a adaptação transcultural para uso no Brasil e a avaliação da validade de conteúdo da Johns Hopkins Fall Risk Assessment Tool para avaliação de risco de quedas e de danos por quedas em pacientes adultos hospitalizados. Método: adaptação transcultural consistiu na tradução da escala para a língua portuguesa (Brasil), retrotradução para a língua de origem, versão de consenso e análise da equivalência transcultural por um comitê de especialistas. A avaliação do conteúdo foi realizada por meio de um comitê de juízes, finalizando com o cálculo do índice de validade de conteúdo dos itens e da escala. Foi realizada a aplicação experimental do instrumento por enfermeiros. Resultados: a versão traduzida da escala passou por duas rodadas de avaliação pelos juízes, a partir das quais os itens com desempenho insatisfatório foram modificados. O índice de validade de conteúdo para itens foi ≥80,0% e o global foi 97,1%. A aplicação experimental mostrou que a escala é de fácil operacionalização. Conclusão: a escala demonstrou conteúdo válido para a avaliação de risco de quedas e de danos por quedas e ser de fácil operacionalização, podendo contribuir para a adequada identificação dos riscos e consequente direcionamento de ações assistenciais.

RESUMEN Objetivo: realizar la adaptación transcultural para ser usada en Brasil y confirmar la validez de contenido de la Johns Hopkins Fall Risk Assessment Tool que evalúa riesgo de caídas y de daños por caídas en pacientes adultos mayores. Método: adaptación transcultural que consistió en la traducción de la escala para el idioma portugués (Brasil); retrotraducción para el idioma de origen; y versión de consenso y análisis de la equivalencia transcultural por un comité de especialistas. La evaluación del contenido fue realizada por medio de un comité de jueces, siendo finalizado con el cálculo del índice de validez de contenido de los ítems y de la escala. Fue realizada la aplicación experimental del instrumento por enfermeros. Resultados: la versión traducida de la escala pasó por dos vueltas de evaluación por los jueces, a partir de las cuales los ítems con desempeño insatisfactorio fueron modificados. El índice de validez de contenido para los ítems fue ≥80,0% y el global fue 97,1%. La aplicación experimental mostró que la escala es de fácil ejecución. Conclusión: la escala demostró tener un contenido válido para la evaluación de riesgo de caídas y de daños por caídas, y de ser de fácil ejecución; esta escala puede contribuir para la adecuada identificación de los riesgos y consecuentemente para la orientación de acciones asistenciales.

[Time trend of the rates of cesarean and vaginal delivery according to the source of financing]. / Tendência temporal da via de parto de acordo com a fonte de financiamento.

PURPOSE: To analyze the time trend of the rates of cesarean and vaginal delivery according to the source of financing. METHODS: This was an ecological study of the time series analysis of cesarean and vaginal delivery rates according to the financing source, carried out in Maringá, Paraná State, Brazil, from 2002 to 2012. Information available at the System of Information on Live Births and at the System of Hospital Information of the Brazilian Unified Health System (SUS) was used for data collection. Moving averages were calculated for all mode of delivery rates in order to smooth random fluctuations in the series, dispersion diagrams were designed between the coefficients and years of the study, and polynomial regression models were estimated from the functional relation observed, with the level of significance set at p<0.05. RESULTS: Throughout the 11 years of the study there were 48,210 births, 77.1% by cesarean delivery and only 22.9% by vaginal delivery. A total of 22,366 procedures were financed by SUS, 54.6% of them being cesareans. Trend analysis was significant for all the regression models, demonstrating an ascending trend for cesarean delivery and a descending trend for vaginal delivery for both types of financing. The non-SUS cesarean rates always exceeded 90.0% and were more frequent than the SUS cesarean rates, even with a 36.0% increase of the latter during the study period. CONCLUSION: Based on trend analysis, cesarean deliveries will continue to increase in both health financing sources unless new actions and strategies of reduction are implemented, involving the sociocultural, demographic and obstetric characteristics of women, the training and activity of professionals in the area of obstetrics and an adequate structure of health services for providing vaginal delivery.

Tendência temporal da via de parto de acordo com a fonte de financiamento / Time trend of the rates of cesarean and vaginal delivery according to the source of financing

OBJETIVO: Analisar a tendência temporal das taxas das vias de parto de acordo com a fonte de financiamento. MÉTODOS: Trata-se de um estudo ecológico de séries temporais de análise das taxas das vias de parto de acordo com a fonte de financiamento, no município de Maringá, Paraná, de 2002 a 2012. Para coleta de dados foram utilizadas as informações disponíveis no Sistema de Informações sobre Nascidos Vivos e no Sistema de Informações Hospitalares do Sistema Único de Saúde (SUS). Para todas as taxas das vias de parto foram calculadas as médias móveis, para suavizar as oscilações aleatórias da série, feitos diagramas de dispersão entre os coeficientes e os anos de estudo, e a partir da relação funcional observada foram estimados modelos de regressão polinomial, com nível de significância de p<0,05. RESULTADOS: No decorrer dos 11 anos do estudo ocorreram 48.220 nascimentos. Desses, 77,1% foram parto cesáreo e apenas 22,9% parto vaginal. Os partos financiados pelo SUS totalizaram 22.366 procedimentos e desses, 54,6% foram cesáreas. A análise da tendência foi significativa para todos os modelos de regressão, evidenciando tendência ascendente para parto cesáreo e decrescente para parto vaginal nos dois tipos de financiamento. Observa-se que as taxas de cesárea não SUS foram sempre superiores a 90,0% e mais frequentes do que as cesáreas SUS, mesmo com o aumento de 36,0% dessas ao longo do período estudado. CONCLUSÃO: Pela análise de tendência, as cesáreas continuarão aumentando nos dois financiamentos de saúde se não forem implantadas novas ações e estratégias de redução envolvendo as características socioculturais, demográficas e obstétrica das mulheres, a formação ...

PURPOSE: To analyze the time trend of the rates of cesarean and vaginal delivery according to the source of financing. METHODS: This was an ecological study of the time series analysis of cesarean and vaginal delivery rates according to the financing source, carried out in Maringá, Paraná State, Brazil, from 2002 to 2012. Information available at the System of Information on Live Births and at the System of Hospital Information of the Brazilian Unified Health System (SUS) was used for data collection. Moving averages were calculated for all mode of delivery rates in order to smooth random fluctuations in the series, dispersion diagrams were designed between the coefficients and years of the study, and polynomial regression models were estimated from the functional relation observed, with the level of significance set at p<0.05. RESULTS: Throughout the 11 years of the study there were 48,210 births, 77.1% by cesarean delivery and only 22.9% by vaginal delivery. A total of 22,366 procedures were financed by SUS, 54.6% of them being cesareans. Trend analysis was significant for all the regression models, demonstrating an ascending trend for cesarean delivery and a descending trend for vaginal delivery for both types of financing. The non-SUS cesarean rates always exceeded 90.0% and were more frequent than the SUS cesarean rates, even with a 36.0% increase of the latter during the study period. CONCLUSION: Based on trend analysis, cesarean deliveries will continue to increase in both health financing sources unless new actions and strategies of reduction are implemented, involving the sociocultural, demographic and obstetric characteristics of women, the training and activity of professionals in the area of obstetrics and an adequate structure of health services for providing vaginal delivery. .